Abstract W MP100: Hospital SAH Volume Associated With Better Outcomes
Objective: The net impact of hospital care on outcomes in subarachnoid hemorrhage (SAH) has not been well established. We hypothesized that increased experience and technical expertise at high volume hospitals would lead to better outcomes.
Methods: We performed a serial cross-sectional retrospective study using the Nationwide Inpatient Sample from 2002-2010. All adult (>18 years) discharges with a primary diagnosis of SAH (ICD-9-CM 435) from 2002-2010 were included and records with trauma or AVM were excluded. Survey-weighted descriptive statistics were used to estimate temporal trends. Multi-level logistic regression was used to estimate volume-outcome associations for two outcomes: inpatient mortality and discharge home. Models were adjusted for demographics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and APR-DRG mortality. Analyses were repeated by excluding records where aggressive care was not pursued _ no intubation, no procedures and in-hospital death within 48 hours.
Results: A total of 66,818 discharges were included in the weighted sample, including 19, 356 who received clipping or coiling. Inpatient mortality declined from 32.2% (30.1%- 33.9%) to 22.2% (20.8%-23.6%) from 2002 to 2010 while discharges to home increased from 28.5% (27.0-30.03%) to 40.8% (39.1%-42.4%). Hospitals in the highest volume quintile (greater than 63 discharges per year) had an unadjusted inpatient mortality of 22.7% (95% CI 22.0%-23.2%) compared to 41.5% (39.0%-43.7%) in quintile 3 (11-21 discharges per year) compared to 51.9% (47.0 -55.7%) in quintile 1 (less than 6 discharges per year). Similar trends were observed when excluding cases where aggressive care was not pursued. The proportion of patients discharged home also increased with hospital volume: 39.3 %( 38.0-39.9%) in quintile 5 vs. 23.2% (21.0%-25.1%) in quintile 3 vs. 16.7% (13.0%-19.7%) in quintile 1.
Conclusion: Inpatient SAH mortality has decreased over time while the likelihood of discharge home has increased. High volume hospitals have more favorable outcomes than low volume hospitals and the magnitude of this effect is substantial. SAH volume should be accounted for in developing SAH systems of care.
Author Disclosures: A.S. Pandey: None. N. Chaudhary: None. J.J. Gemmete: None. B.G. Thompson: None. J. Burke: None.
- © 2014 by American Heart Association, Inc.