This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/2206    most recent 01.STR.0000089683.66849.5Ev1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Matz, P. G. Search for Related Content PubMed PubMed Citation Articles by Matz, P. G.

(Stroke. 2003;34:2206.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Spontaneous Subarachnoid Hemorrhage: Volume, Experience, and Outcome

Division of Neurosurgery, University of Alabama, Birmingham, Alabama

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In recent years, there has been a trend in neurosurgery and other fields toward both subspecialization (as evidenced by the recent accreditation of the specialty Endovascular Surgical Neuroradiology by the ACGME) and regional specialization. This trend has been propelled by increases in medical and technical knowledge. The current medicolegal environment also has probably fueled this trend. It has been hypothesized that regional specialization permits greater efficiency and improved outcome while minimizing costs and complications. Accordingly, Kalkanis et al examined a cohort of patients with cranial neuralgia who required microvascular decompression.¹ These authors found that higher-volume hospitals and surgeons had better discharge outcomes with fewer complications and more discharges to home. Similarly, Long and colleagues examined patients who received craniotomies for tumor resection.² The mortality rates, hospital costs, and length of stay were all more favorable in higher-volume centers.

Focusing on subarachnoid hemorrhage (SAH), Bardach et al reviewed the admission diagnoses of SAH over a 10-year period in California using an available database for nonfederal hospitals.³ Rates of mortality, adverse outcome, length of stay, and hospital charges were computed and analyzed with multivariate analysis. Hospital volume directly impacted mortality, with the lowest quartile having a 49% rate compared with the highest quartile (32%, P<0.001). In multivariate analysis, the difference persisted with an odds ratio of 0.57 (95% CI 0.48 to 0.67, P<0.001). In looking at therapy for SAH in patients older than 65 with Medicare, Taylor and colleagues undertook an analysis to determine if a relationship existed between surgical . . . [Full Text of this Article]

This article has been cited by other articles:

				J. B. Bederson, E. S. Connolly Jr, H. H. Batjer, R. G. Dacey, J. E. Dion, M. N. Diringer, J. E. Duldner Jr, R. E. Harbaugh, A. B. Patel, and R. H. Rosenwasser Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association Stroke, March 1, 2009; 40(3): 994 - 1025. [Full Text] [PDF]

				N. S. Bardach, S. J. Olson, J. S. Elkins, W. S. Smith, M. T. Lawton, and S. C. Johnston Regionalization of Treatment for Subarachnoid Hemorrhage: A Cost-Utility Analysis Circulation, May 11, 2004; 109(18): 2207 - 2212. [Abstract] [Full Text] [PDF]