Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes

Tiffany R Chang; Robert G Kowalski; J Ricardo Carhuapoma; Rafael J Tamargo; Neeraj S Naval

doi:10.1016/j.jcrc.2015.01.007

Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes

J Crit Care. 2015 Jun;30(3):469-72. doi: 10.1016/j.jcrc.2015.01.007. Epub 2015 Jan 10.

Authors

Tiffany R Chang¹, Robert G Kowalski², J Ricardo Carhuapoma³, Rafael J Tamargo⁴, Neeraj S Naval⁵

Affiliations

¹ Departments of Neurosurgery and Neurology, University of Texas Medical School, Houston, TX. Electronic address: Tiffany.R.Chang@uth.tmc.edu.
² Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rkowalski@gmail.com.
³ Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jcarhua1@jhmi.edu.
⁴ Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rtamarg@jhmi.edu.
⁵ Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: nnaval1@jhmi.edu.

PMID: 25648904
DOI: 10.1016/j.jcrc.2015.01.007

Abstract

Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners.

Materials and methods: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents.

Results: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%).

Conclusions: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.

Keywords: Aneurysm; Case volume; Caseload; Neurocritical care unit; Outcome; Subarachnoid hemorrhage.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adult
Aged
Clinical Competence
Comorbidity
Female
Hospital Mortality
Hospitals, High-Volume*
Humans
Intensive Care Units
Male
Middle Aged
Outcome Assessment, Health Care
Retrospective Studies
Subarachnoid Hemorrhage / mortality*
Treatment Outcome