National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Ryota Kurogi; Akiko Kada; Kuniaki Ogasawara; Kunihiro Nishimura; Takanari Kitazono; Toru Iwama; Yuji Matsumaru; Nobuyuki Sakai; Yoshiaki Shiokawa; Shigeru Miyachi; Satoshi Kuroda; Hiroaki Shimizu; Shinichi Yoshimura; Toshiaki Osato; Nobutaka Horie; Izumi Nagata; Kazuhiko Nozaki; Isao Date; Yoichiro Hashimoto; Haruhiko Hoshino; Hiroyuki Nakase; Hiroharu Kataoka; Tsuyoshi Ohta; Hitoshi Fukuda; Nanako Tamiya; A I Kurogi; Nice Ren; Ataru Nishimura; Koichi Arimura; Takafumi Shimogawa; Koji Yoshimoto; Daisuke Onozuka; Soshiro Ogata; Akihito Hagihara; Nobuhito Saito; Hajime Arai; Susumu Miyamoto; Teiji Tominaga; Koji Iihara; J-ASPECT Study Collaborators

doi:10.1136/bmjopen-2022-068642

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

BMJ Open. 2023 Apr 10;13(4):e068642. doi: 10.1136/bmjopen-2022-068642.

Authors

Ryota Kurogi¹, Akiko Kada², Kuniaki Ogasawara³, Kunihiro Nishimura⁴, Takanari Kitazono⁵, Toru Iwama⁶, Yuji Matsumaru⁷, Nobuyuki Sakai⁸, Yoshiaki Shiokawa⁹, Shigeru Miyachi¹⁰, Satoshi Kuroda¹¹, Hiroaki Shimizu¹², Shinichi Yoshimura¹³, Toshiaki Osato¹⁴, Nobutaka Horie¹⁵, Izumi Nagata¹⁶, Kazuhiko Nozaki¹⁷, Isao Date¹⁸, Yoichiro Hashimoto¹⁹, Haruhiko Hoshino²⁰, Hiroyuki Nakase²¹, Hiroharu Kataoka²², Tsuyoshi Ohta²², Hitoshi Fukuda²³, Nanako Tamiya²⁴, A I Kurogi¹, Nice Ren¹, Ataru Nishimura¹, Koichi Arimura¹, Takafumi Shimogawa¹, Koji Yoshimoto¹, Daisuke Onozuka⁴, Soshiro Ogata⁴, Akihito Hagihara⁴, Nobuhito Saito²⁵, Hajime Arai²⁶, Susumu Miyamoto²⁷, Teiji Tominaga²⁸, Koji Iihara²⁹; J-ASPECT Study Collaborators

Collaborators

J-ASPECT Study Collaborators:
Hidekazu Takahashi, Isao Sasaki, Kazuo Kitazawa, Minoru Saitoh, Hitoshi Saito, Hiroaki Shimizu, Minoru Asahi, Makoto Goda, Atsuhito Takemura, Tatsuya Sasaki, Masaaki Shibukawa, Isao Fuwa, Saburo Watanabe, Seiko Kataoka, Koji Takasaki, Kouji Shiga, Kensuke Hayashida, Hidefuku Gi, Ryunosuke Uranishi, Toshihiko Iuchi, Junichi Ono, Chiaki Ito, Kenji Wakui, Takashi Saegusa, Isao Kitahara, Yasushi Ejima, Hiroshi Tanaka, Satoru Hayashi, Kazuyoshi Hattori, Shinji Okita, Toshikazu Ichihashi, Tsugumichi Ichioka, Shinichi Shirakami, Takeshi Matsuoka, Akio Hyodo, Teruo Kimura, Tomonori Kobayashi, Kanehisa Kohno, Kazunori Yamanaka, Akira Morooka, Nozomi Mori, Hideo Kunimine, Kazutaka Yatsushiro, Masahiro Satoh, Ichiro Nakahara, Syougo Imae, Hirochiyo Wada, Mamoru Murakami, Masanori Kabuto, Katsuyuki Hirakawa, Isao Inoue, Hidenori Yoshida, Kiyoshi Kazekawa, Masani Nonaka, Kouzou Fukuyama, Shigenari Kin, Kiyoshi Saito, Yoichi Watanabe, Tadashi Arisawa, Kou Takahashi, Tetsuya Tanigawara, Junki Ito, Toru Iwama, Kei Hisada, Makoto Takeda, Jun Niwa, Mikio Nishiya, Shuji Hayashi, Ichiro Fujishima, Teiji Nakayama, Yoshihiko Watanabe, Koichirou Matsukado, Takamichi Yuguchi, Tadahisa Shono, Hiroyuki Nishimura, Jyunya Hayashi, Keisuke Migita, Kazuhiro Yokoyama, Naofumi Isono, Satoshi Utsuki, Hirotoshi Ohtaka, Takata Hisashi, Takamitsu Uchizawa, Hiroki Ohkuma, Shigeki Nishino, Atsushi Tominaga, Masayuki Sumida, Kaoru Kurisu, Naoki Shinohara, Kiyohiro Houkin, Mitsunobu Kaijima, Kazumi Nitta, Junkoh Yamamoto, Shinichi Yoshimura, Yoshio Sakagami, Hideo Aihara, Takayuki Sakaki, Hiroko Oyama, Keishi Fujita, Sumio Kobayashi, Nobuaki Momozaki, Atsushi Sato, Hideki Murakami, Masahito Hara, Akazi Kazunori, Fumitaka Miya, Hisato Minamide, Tsuyoshi Inoue, Shinichiro Kurokawa, Syuichi Ishikawa, Naohisa Miura, Shinya Noda, Shoji Mashiyama, Shinji Amano, Kuniaki Ogasawara, Takayuki Sugawara, Yukihiko Shimizu, Keiichi Saito, Kazuyuki Miura, Akinori Yabuta, Tatumi Yamanome, Hiroshi Seto, Makoto Hasebe, Hikaru Mizobuchi, Junkoh Sasaki, Shin Tsuruoka, Keiichi Nishimaki, Katsumi Takizawa, Hiroki Toda, Hitoshi Tsugu, Nozomi Suzuki, Takeshi Kohno, Shu Hasegawa, Ken Asakura, Ichiro Suzuki, Masaki Miyatake, Hiromu Konno, Katsunobu Takenaka, Akira Ikeda, Keizou Yamamoto, Yoshihiro Nishiura, Keigo Matsumoto, Kazunari Koga, Satoshi Inoha, Masaki Morisige, Kunihiko Harada, Hirofumi Hiyama, Yasuaki Takeda, Taturou Mori, Takekazu Akiyama, Osamu Okuda, Hajime Arai, Kazuaki Awamori, Naoki Shirasaki, Kimihiro Yoshino, Atsushi Shindo, Kazuho Hirahara, Shunichi Tanaka, Teruaki Kawano, Kazunori Arita, Hiroaki Sawaura, Hiromu Hadeishi, Yoichi Uozumi, Masahiko Tanaka, Shunsuke Shiraga, Shuji Sato, Mitsutoshi Nakada, Kimihisa Kinoshita, Nakazawa Kazutomo, Yasuhiro Fujimoto, Kunikazu Yoshimura, Masaaki Iwase, Shinichi Yagi, Atsushi Tsuchiya, Junichi Harashina, Akira Watanabe, Sadao Kaneko, Naoto Kuwayama, Junya Hayashi, Masaaki Uno, Masayuki Sasou, Sotaro Higashi, Kazunari Yoshida, Masakazu Kitahara, Satoshi Suzuki, Sumio Suda, Amami Kato, Yusaku Nakamura, Satoshi Magarisawa, Kenji Hashimoto, Hiroyuki Matsumoto, Hirotoshi Hamaguchi, Tomohiko Satou, Masaru Idei, Haruhisa Tsukamoto, Eiichiro Kamatsuka, Toshihiro Kumabe, Naoaki Sato, Yasuyuki Toba, Nobuyuki Sakai, Takashi Tominaga, Haruo Yamashita, Eiji Kohmura, Masanori Morimoto, Tetsuya Ueba, Toyoaki Shinohara, Kazuyoshi Watanabe, Hidenori Endo, Kenjirou Hujiwara, Kenjirou Hujiwara, Toshinori Hasegawa, Hisashi Nitta, Kuroyanagi Takayuki, Nobuhiko Mizutani, Akira Tsunoda, Fumio Suzuki, Tetsuya Morimoto, Takuya Kawai, Mitsuyuki Fujitsuka, Akira Takada, Hiromasa Tsuiki, Junichi Kuratsu, Masaki Chin, Hidemichi Sasayama, Shigehiro Ohmori, Seiko Hasegawa, Hidekazu Takahashi, Isao Sasaki, Kazuo Kitazawa, Minoru Saitoh, Hitoshi Saito, Hiroaki Shimizu, Minoru Asahi, Makoto Goda, Atsuhito Takemura, Tatsuya Sasaki, Masaaki Shibukawa, Isao Fuwa, Saburo Watanabe, Seiko Kataoka, Koji Takasaki, Kouji Shiga, Kensuke Hayashida, Hidefuku Gi, Ryunosuke Uranishi, Toshihiko Iuchi, Junichi Ono, Chiaki Ito, Kenji Wakui, Takashi Saegusa, Isao Kitahara, Yasushi Ejima, Hiroshi Tanaka, Satoru Hayashi, Kazuyoshi Hattori, Shinji Okita, Toshikazu Ichihashi, Tsugumichi Ichioka, Shinichi Shirakami, Takeshi Matsuoka, Akio Hyodo, Teruo Kimura, Tomonori Kobayashi, Kanehisa Kohno, Kazunori Yamanaka, Akira Morooka, Nozomi Mori, Hideo Kunimine, Kazutaka Yatsushiro, Masahiro Satoh, Ichiro Nakahara, Syougo Imae, Hirochiyo Wada, Mamoru Murakami, Masanori Kabuto, Katsuyuki Hirakawa, Isao Inoue, Hidenori Yoshida, Kiyoshi Kazekawa, Masani Nonaka, Kouzou Fukuyama, Shigenari Kin, Kiyoshi Saito, Yoichi Watanabe, Tadashi Arisawa, Kou Takahashi, Tetsuya Tanigawara, Junki Ito, Toru Iwama, Kei Hisada, Makoto Takeda, Jun Niwa, Mikio Nishiya, Shuji Hayashi, Ichiro Fujishima, Teiji Nakayama, Yoshihiko Watanabe, Koichirou Matsukado, Takamichi Yuguchi, Tadahisa Shono, Hiroyuki Nishimura, Jyunya Hayashi, Keisuke Migita, Kazuhiro Yokoyama, Naofumi Isono, Satoshi Utsuki, Hirotoshi Ohtaka, Takata Hisashi, Takamitsu Uchizawa, Hiroki Ohkuma, Shigeki Nishino, Atsushi Tominaga, Masayuki Sumida, Kaoru Kurisu, Naoki Shinohara, Kiyohiro Houkin, Mitsunobu Kaijima, Kazumi Nitta, Junkoh Yamamoto, Shinichi Yoshimura, Yoshio Sakagami, Hideo Aihara, Takayuki Sakaki, Hiroko Oyama, Keishi Fujita, Sumio Kobayashi, Nobuaki Momozaki, Atsushi Sato, Hideki Murakami, Masahito Hara, Akazi Kazunori, Fumitaka Miya, Hisato Minamide, Tsuyoshi Inoue, Shinichiro Kurokawa, Syuichi Ishikawa, Naohisa Miura, Shinya Noda, Shoji Mashiyama, Shinji Amano, Kuniaki Ogasawara, Takayuki Sugawara, Yukihiko Shimizu, Keiichi Saito, Kazuyuki Miura, Akinori Yabuta, Tatumi Yamanome, Hiroshi Seto, Makoto Hasebe, Hikaru Mizobuchi, Junkoh Sasaki, Shin Tsuruoka, Keiichi Nishimaki, Katsumi Takizawa, Hiroki Toda, Hitoshi Tsugu, Nozomi Suzuki, Takeshi Kohno, Shu Hasegawa, Ken Asakura, Ichiro Suzuki, Masaki Miyatake, Hiromu Konno, Katsunobu Takenaka, Akira Ikeda, Keizou Yamamoto, Yoshihiro Nishiura, Keigo Matsumoto, Kazunari Koga, Satoshi Inoha, Masaki Morisige, Kunihiko Harada, Hirofumi Hiyama, Yasuaki Takeda, Taturou Mori, Takekazu Akiyama, Osamu Okuda, Hajime Arai, Kazuaki Awamori, Naoki Shirasaki, Kimihiro Yoshino, Atsushi Shindo, Kazuho Hirahara, Shunichi Tanaka, Teruaki Kawano, Kazunori Arita, Hiroaki Sawaura, Hiromu Hadeishi, Yoichi Uozumi, Masahiko Tanaka, Shunsuke Shiraga, Shuji Sato, Mitsutoshi Nakada, Kimihisa Kinoshita, Nakazawa Kazutomo, Yasuhiro Fujimoto, Kunikazu Yoshimura, Masaaki Iwase, Shinichi Yagi, Atsushi Tsuchiya, Junichi Harashina, Akira Watanabe, Sadao Kaneko, Naoto Kuwayama, Junya Hayashi, Masaaki Uno, Masayuki Sasou, Sotaro Higashi, Kazunari Yoshida, Masakazu Kitahara, Satoshi Suzuki, Sumio Suda, Amami Kato, Yusaku Nakamura, Satoshi Magarisawa, Kenji Hashimoto, Hiroyuki Matsumoto, Hirotoshi Hamaguchi, Tomohiko Satou, Masaru Idei, Haruhisa Tsukamoto, Eiichiro Kamatsuka, Toshihiro Kumabe, Naoaki Sato, Yasuyuki Toba, Nobuyuki Sakai, Takashi Tominaga, Haruo Yamashita, Eiji Kohmura, Masanori Morimoto, Tetsuya Ueba, Toyoaki Shinohara, Kazuyoshi Watanabe, Hidenori Endo, Kenjirou Hujiwara, Kenjirou Hujiwara, Toshinori Hasegawa, Hisashi Nitta, Kuroyanagi Takayuki, Nobuhiko Mizutani, Akira Tsunoda, Fumio Suzuki, Tetsuya Morimoto, Takuya Kawai, Mitsuyuki Fujitsuka, Akira Takada, Hiromasa Tsuiki, Junichi Kuratsu, Masaki Chin, Hidemichi Sasayama, Shigehiro Ohmori, Seiko Hasegawa, Kazuhiro Kikuchi, Motohiro Morioka, Masanori Isobe, Masanori Isobe, Masayuki Yokota, Nozomu Murai, Yasumasa Yamamoto, Nobuhito Mori, Minoru Kidooka, Hiroshi Tenjin, Susumu Miyamoto, Yoshihiro Iwamoto, Hitonori Takaba, Sei Haga, Koji Iihara, Yoshinori Arai, Toshiyuki Tsukada, Hirohide Karasudani, Kenji Hashimoto, Masakazu Suga, Kawamoto Yukihiko, Hiroaki Fujiwara, Naoto Izumi, Youtarou Takeuchi, Motohiro Arai, Hidenori Suzuki, Shinji Okumura, Hiromasa Tsuiki, Tomoyoshi Oikawa, Hisashi Tanaka, Yasushi Shibata, Tetsuya Masaoka, Takashi Matsuoka, Masahiko Kasai, Hitoshi Miyake, Hajime Ohta, Osamu Hamasaki, Misao Nishikawa, Naohiko Kubo, Yosimasa Kinosita, Hiroshi Ooyama, Hiroyuki Kaidu, Tarou Komuro, Hiroaki Shigeta, Yoshikazu Kusano, Shigekazu Takeuchi, Takayuki Matsuo, Yoshiharu Tokunaga, Norimoto Nakahara, Nobukazu Hashimoto, Mitsuhito Mase, Keizo Yasui, Junpei Yoshimoto, Toshihiko Wakabayashi, Jin Momoji, Kenji Kamiyama, Koji Oka, Hiromichi Koga, Kazuya Morimoto, Tsutomu Kadekaru, Hiroyuki Nakase, Junichi Iida, Michio Nakamura, Hiroharu Kataoka, Naoki Tokumitsu, Yasuyuki Nagai, Hirokazu Tanno, Hiroyuki Masaoka, Hiroshi Nakane, Takato Kagawa, Masaaki Saiki, Satoshi Ushikoshi, Kotaro Ogihara, Junichi Imamura, Katsuhiro Yamashita, Akira Nakamizo, Yoshinari Nakamura, Ei-Ichirou Urasaki, Noriyuki Suzaki, Hidehiro Hirabayashi, Chiaki Takahashi, Youichirou Namba, Kazuo Hashikawa, Tomonori Yamada, Masayuki Ezura, Kazuyuki Kuwayama, Keiichi Sakai, Katsuhiro Kuroda, Hideyuki Kurihara, Masayuki Ishihara, Hideki Sakai, Masayuki Miyazono, Kosuke Miyahara, Atsuo Yoshino, Hideaki Takahashi, Akihiko Saito, Hiroyuki Arai, Igarashi Michitoku, Mitsuo Kouno, Osamu Onodera, Shiro Kobayashi, Shunichi Yoneda, Hiroshi Kusunoki, Naoya Takeda, Hiroji Miyake, Toshio Yokoe, Tatsuya Nakamura, Takayuki Kubodera, Mitsuhiko Hokari, Yasunari Otawara, Cheho Park, Hidemitu Nakagawa, Kensuke Kawai, Souichi Obara, Haruki Takahashi, Masafumi Ohtaki, Atsuya Okubo, Katsuhiko Hayashi, Hideyuki Ohnishi, Masahisa Kawakami, Yu Takeda, Akihiko Kaga, Yutaka Yamaguchi, Ryoichi Hayashi, Koji Tokunaga, Hiroyuki Nakashima, Yasuyuki Miyoshi, Isao Date, Atusi Kimoto, Satoshi Yamamoto, Toshimitsu Uchihara, Tomoaki Nagamine, Masahiro Noha, Hiromichi Sadashima, Toshihiko Kinjo, Osamu Tao, Masayuki Nakajima, Akira Isoshima, Kouichi Kuramoto, Shigeru Daido, Yoshiyasu Iwai, Kenji Ohata, Manabu Kinoshita, Toshihiko Kuroiwa, Akatsuki Wakayama, Naoki Hayashi, Kohsuke Yamashita, Yasunobu Gotou, Kouich Iwatsuki, Yoshida Masahiro, Nobuaki Kobayasi, Yoshimasa Niiya, Syouji Mabuchi, Motohiro Takayama, Masaaki Saiki, Kazuo Yamamoto, Junta Moroi, Susumu Suzuki, Tatsuya Abe, Hiroshi Sugimori, Masato Sugitani, Akio Ookura, Naoko Fujimura, Osamu Nishizaki, Sumio Isimaru, Toru Nishi, Hiroshi Wanihuchi, Nobukuni Murakami, Hiroto Murata, Naoki Kitagawa, Katsuhiko Kono, Michiya Kubo, Masashi Nakatsukasa, Yuji Okamoto, Makoto Inaba, Hidetoshi Ooigawa, Atsuhiro Kojima, Kyoichi Nomura, Takamitsu Fujimaki, Kenji Yamamoto, Osamu Fukuda, Yoshikazu Nakajima, Kazuyuki Kouno, Takaaki Yoshida, Reizou Kanemaru, Yohei Kudoh, Toshitaka Nakamura, Masayoshi Takigami, Shogo Nishi, Nobuhiro Mikuni, Akira Takahashi, Rokuya Tanikawa, Seisaburo Sakamoto, Makio Kaminogo, Seiichiro Hoshi, Yoshinari Okumura, Shinichi Okabe, Haruhiko Sato, Shiro Miyata, Kotaro Tsumura, Hiroshi Karibe, Noriaki Watabe, Kazuhiko Nozaki, Fusao Ikawa, Takashi Yoshida, Ryuji Nakamura, Norifumi Shimoeda, Tsutomu Hitotsumatsu, Tomoaki Kameda, Hiroshi Ishiguchi, Atsuo Shinoda, Masanobu Hokama, Akinori Yamamura, Kazuhiro Hongo, Takeshi Kondoh, Makoto Ichinose, Takashi Inoue, Kenichi Murao, Takafumi Wataya, Seiji Fukazawa, Takahisa Mori, Shinsuke Muraoka, Tomoaki Terada, Hirosuke Fujisawa, Tsuneo Shishido, Mayumi Mori, Arai Hiroaki, Shinjitsu Nishimura, Zenichiro Watanabe, Yuichiro Tanaka, Yasunari Niimi, Susumu Nakashima, Akira Nakamizo, Shinichi Wakabayashi, Kazuhito Nakamura, Hiroki Sato, Yukinari Kakizawa, Hiroki Takano, Norihito Shirakawa, Masahiro Kagawa, Eiichiro Mabuchi, Kazusige Maeno, Takayuki Koizumi, Warou Taki, Yusuke Nakagaki, Kazuyuki Tane, Hiromichi Ooishi, Katsuyuki Asaoka, Yoshinori Akiyama, Tadao Kawamura, Atumi Takenobu, Masayuki Yokota, Takehisa Tuji, Teiji Tominaga, Masami Shimoda, Mitsunori Matsumae, Shinji Noda, Koiti Moroki, Hirofumi Oka, Masahito Agawa, Hajimu Miyake, Junichiro Satomi, Masateru Katayama, Shinichi Numazawa, Taketoshi Maehara, Hiroyuki Jimbo, Michihiro Kohno, Satoshi Ihara, Koji Matuoka, Oikawa Akihiro, Kensaku Yoshida, Takahiro Oota, Haruhiko Hoshino, Makoto Noguchi, Takakazu Kawamata, Youichi Hashimoto, Keiichirou Onitsuka, Masahiko Kitano, Jae-Hyun Son, Toru Masuoka, Naoki Koketsu, Keiichi Akatsuka, Masamichi Kurosaki, Miyamori Tadao, Hiroaki Hondo, Kazumasa Yamatani, Satoshi Kuroda, Hirofumi Oyama, Takashi Matsumoto, Junji Koyama, Ogura Koichiro, Shinji Yamamoto, Hitoshi Tabata, Kazuya Uemura, Kazuhiko Sato, Hideyuki Yoshida, Takafumi Nishizaki, Hiroshi Egami, Osamu Yamamura, Hideo Takeshima, Shogo Ishiuchi, Akira Matsumura, Hiroyuki Kinouchi, Susumu Mekaru, Mikihiko Takeshita, Hitoshi Ozawa, Kiichiro Zenke, Takeshi Matsuyama, Naoyuki Nakao, Toshikazu Kuwata, Teruyuki Habu, Tomoyoshi Okumura, Seiya Takehara, Rei Kondo, Takashi Kumagai, Keiten So, Sunao Takemura, Sonoda Yukihiko, Manabu Urakawa, Yasuhiro Hamada, Michiyasu Suzuki, Mikito Uchida, Hidehito Koizumi, Hiroshi Ozawa, Masaru Yamada, Takashi Tsuruno, Gen Ishida, Ryouichi Masuda, Makoto Kimura, Shinichirou Ishihara, Masashi Morikawa, Sachio Suzuki, Hiroaki Tanaka, Hidetoshi Murata, Katsumi Sakata, Motohiro Nomura, Akihiro Nemoto, Sumio Endou, Nobuo Hirota, Kennji Itou, Hiroaki Minami, Yoshihumi Teramoto

Affiliations

¹ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
³ Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
⁴ Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan.
⁵ Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
⁶ Department of Neurosurgery, Gifu University Graduate School of Medicine, Yanagido, Japan.
⁷ Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
⁸ Department of Neurosurgery, Kobe City General Hospital, Kobe, Japan.
⁹ Department of Neurosurgery, Kyorin University, Mitaka, Japan.
¹⁰ Department of Neurosurgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan.
¹¹ Department of Neurosurgery, Toyama University, Toyama, Japan.
¹² Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan.
¹³ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
¹⁴ Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
¹⁵ Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan.
¹⁶ Department of Neurosurgery, Kokura Memorial Hospital, Kita-kyushu, Japan.
¹⁷ Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.
¹⁸ Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
¹⁹ Department of Neurology, Kumamoto City Hospital, Kumamoto, Japan.
²⁰ Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
²¹ Department of Neurosurgery, Nara Medical University, Nara, Japan.
²² Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
²³ Department of Neurosurgery, Kochi Medical School, Nankoku, Japan.
²⁴ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
²⁵ Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
²⁶ Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
²⁷ Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
²⁸ Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
²⁹ Director General, National Cerebral and Cardiovascular Center Hospital, Suita, Japan kiihara@ncvc.go.jp.

Abstract

Objectives: To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.

Design: Retrospective study.

Setting: Six hundred and thirty-one primary care institutions in Japan.

Participants: Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.

Primary and secondary outcome measures: Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points).

Results: In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.

Conclusions: The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

Keywords: Neurosurgery; VASCULAR SURGERY.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Endovascular Procedures* / methods
Humans
Intracranial Aneurysm* / therapy
Japan / epidemiology
Prognosis
Retrospective Studies
Stroke* / complications
Subarachnoid Hemorrhage* / complications
Treatment Outcome