Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

Area of Science:

• Neurosurgery
• Public Health
• Healthcare Management

Background:

• A known inverse relationship exists between hospital case volume and case-fatality for various medical and surgical interventions.
• This association suggests that patient outcomes may be influenced by the number of procedures a hospital performs.

Purpose of the Study:

• To investigate the impact of hospital case volume on patient outcomes following aneurysmal subarachnoid hemorrhage (aSAH).
• To determine if higher case volumes in hospitals correlate with reduced mortality rates for aSAH patients.

Main Methods:

• Analysis of the Dr Foster Stroke GOAL database (2007-2014) including aSAH patients undergoing coiling or clipping.
• Hospitals were categorized into low (<41/year), intermediate (41-70/year), and high (>70/year) annual case volumes.
• 14-day in-hospital case-fatality was the primary outcome, with logistic regression used for adjustments.

Main Results:

• A total of 8525 patients were included. Crude 14-day case-fatality was 10.4% (low volume), 7.0% (intermediate), and 5.4% (high volume).
• Adjusted odds ratios for 14-day case-fatality were significantly lower in intermediate (OR 0.63) and high-volume (OR 0.50) hospitals compared to low-volume.
• This trend persisted for both clipped (OR 0.42-0.46) and coiled (OR 0.56) aneurysms in high-volume centers.

Conclusions:

• Intermediate and high hospital case volumes are associated with reduced case-fatality for aSAH, even within tertiary care centers.
• Findings support the centralization of aSAH care to higher-volume institutions to improve patient survival.
• Optimizing treatment location based on case volume can enhance outcomes for patients with aneurysmal subarachnoid hemorrhage.