J Korean Neurosurg Soc.  2024 Nov;67(6):622-636. 10.3340/jkns.2023.0205.

High-Volume Hospital Had Lower Mortality of Severe Intracerebral Hemorrhage Patients

• Park SW
• Han JJ
• Heo NH
• Lee EC
• Lee DH
• Lee JY
• Lee BC
• Lim YW
• Kim GO
• Oh JS

• KMID: 2560404
• DOI: http://doi.org/10.3340/jkns.2023.0205

Abstract

Objective
: Intracerebral hemorrhage (ICH) accompanies higher mortality rates than other type of stroke. This study aimed to investigate the association between hospital volume and mortality for cases of ICH.
Methods
: We used nationwide data from 2013 to 2018 to compare high-volume hospitals (≥32 admissions/year) and low-volume hospitals (<32 admissions/year). We tracked patients’ survival at 3-month, 1-year, 2-year, and 4-year endpoints. The survival of ICH patients was analyzed at 3-month, 1-year, 2-year, and 4-year endpoints using Kaplan-Meier survival analysis. Multivariable logistic regression analysis and Cox regression analysis were performed to determine predictive factors of poor outcomes at discharge and death.
Results
: Among 9086 ICH patients who admitted to hospital during 18-month period, 6756 (74.4%) and 2330 (25.6%) patients were admitted to high-volume and low-volume hospitals. The mortality of total ICH patients was 18.25%, 23.87%, 27.88%, and 35.74% at the 3-month, 1-year, 2-year, and 4-year, respectively. In multivariate logistic analysis, high-volume hospitals had lower poor functional outcome at discharge than low-volume hospitals (odds ratio, 0.80; 95% confidence interval, 0.72–0.91; p<0.001). In the Cox analysis, high-volume hospitals had significantly lower 3-month, 1-year, 2-year, and 4-year mortality than low-volume hospitals (p<0.05).
Conclusion
: The poor outcome at discharge, short- and long-term mortality in ICH patients differed according to hospital volume. High-volume hospitals showed lower rates of mortality for ICH patients, particularly those with severe clinical status.

Keyword

Cerebral hemorrhage; Mortality; Hospitals; High-volume

Figure

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  Fig. 1. flow chart of study population and patients included in linear model of longitudinal changes in hospital volume. ICH : intracerebral hemorrhage.

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  Fig. 2. Kaplan-Meier estimates for survival probability based on specific conditions of intracerebral hemorrhage patients. A : Total patients stratified by surgery status. B : Total patients stratified by disease severity. C : Patients with mild clinical status stratified by surgery status. D : Patients with severe clinical status stratified by surgery status. E : Total patients stratified by age groups. F : Total patients stratified by sex.

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  Fig. 3. Kaplan-Meier estimate for survival probability based on specific conditions of intracerebral hemorrhage patients according to hospital volume. A : Total patients according to hospital type. B : Total patients undergo surgery according to hospital type. C : Total patients did not undergo surgery according to hospital type. D : Mild clinical status according to hospital type. E : Severe clinical status according to hospital type.

Reference

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