| アブストラクト | OBJECTIVE: Improved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH. METHODS: The authors conducted a nationwide retrospective cohort study in 27,490 SAH patients who underwent clipping or coiling in 621 institutions between 2010 and 2015 and whose data were collected from the Japanese nationwide J-ASPECT Diagnosis Procedure Combination database. The CSC capabilities of each hospital were assessed by use of a validated scoring system based on answers to a previously reported 25-item questionnaire (CSC score 1-25 points). Hospitals were classified into quartiles based on CSC scores and case volumes of clipping or coiling for SAH. RESULTS: Overall, the absolute risk reductions associated with high versus low case volumes and high versus low CSC scores were relatively small. Nevertheless, in patients who underwent clipping, a high case volume (> 14 cases/yr) was significantly associated with reduced in-hospital mortality (Q1 as control, Q4 OR 0.71, 95% CI 0.55-0.90) but not with short-term poor outcome. In patients who underwent coiling, a high case volume (> 9 cases/yr) was associated with reduced in-hospital mortality (Q4 OR 0.69, 95% CI 0.53-0.90) and short-term poor outcomes (Q3 [> 5 cases/yr] OR 0.75, 95% CI 0.59-0.96 vs Q4 OR 0.65, 95% CI 0.51-0.82). A high CSC score (> 19 points) was significantly associated with reduced in-hospital mortality for clipping (OR 0.68, 95% CI 0.54-0.86) but not coiling treatment. There was no association between CSC capabilities and short-term poor outcomes. CONCLUSIONS: The effects of case volume and CSC capabilities on in-hospital mortality and short-term functional outcomes in SAH patients differed between patients undergoing clipping and those undergoing coiling. In the modern endovascular era, better outcomes of clipping may be achieved in facilities with high CSC capabilities. |
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| ジャーナル名 | Journal of neurosurgery |
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| 投稿日 | 2020/3/14 |
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| 投稿者 | Kurogi, Ryota; Kada, Akiko; Ogasawara, Kuniaki; Kitazono, Takanari; Sakai, Nobuyuki; Hashimoto, Yoichiro; Shiokawa, Yoshiaki; Miyachi, Shigeru; Matsumaru, Yuji; Iwama, Toru; Tominaga, Teiji; Onozuka, Daisuke; Nishimura, Ataru; Arimura, Koichi; Kurogi, Ai; Ren, Nice; Hagihara, Akihito; Nakaoku, Yuriko; Arai, Hajime; Miyamoto, Susumu; Nishimura, Kunihiro; Iihara, Koji |
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| 組織名 | 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu;University, Fukuoka.;2Department of Clinical Trials and Research, National Hospital Organization,;Nagoya Medical Center, Nagoya.;3Department of Neurosurgery, Iwate Medical University, Morioka.;4Department of Medicine and Clinical Science, Graduate School of Medical;Sciences, Kyushu University, Fukuoka.;5Department of Neurosurgery, Kobe City Medical Centre General Hospital, Kobe.;6Department of Neurology, Kumamoto City Hospital, Kumamoto.;7Department of Neurosurgery, Kyorin University School of Medicine, Mitaka.;8Department of Neurosurgery, Aichi Medical University, Nagakute.;9Department of Neurosurgery, University of Tsukuba, Tsukuba.;10Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu.;11Department of Neurosurgery, Tohoku University School of Medicine, Sendai.;12Department of Preventive Medicine and Epidemiology, National Cerebral and;Cardiovascular Center, Suita.;13Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and.;14Department of Neurosurgery, Kyoto University Graduate School of Medicine,;Kyoto, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32168489/ |
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