Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)469-472
Number of pages4
JournalJournal of Critical Care
Volume30
Issue number3
DOIs
StatePublished - Jun 1 2015

Keywords

  • Aneurysm
  • Case volume
  • Caseload
  • Neurocritical care unit
  • Outcome
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes'. Together they form a unique fingerprint.

Cite this