Table_2_Short- and long-term mortality of subarachnoid hemorrhage according to hospital volume and severity using a nationwide multicenter registry study.DOCX

IntroductionRecent improvements in treatment for subarachnoid hemorrhage (SAH) have decreased the mortality rates; however, the outcomes of SAH management are dependent on many other factors. In this study, we used nationwide, large-scale, observational data to investigate short- and long-term mortality rates after SAH treatment and the influence of patient severity and hospital volume.
Patients and methodsWe selected patients with SAH treated with clipping and coiling from the South Korean Acute Stroke Assessment Registry. High- and low-volume hospitals performed ≥20 clipping and coiling procedures and <20 clipping and coiling procedures per year, respectively. Short- and long-term mortality were tracked using data from the Health Insurance Review and Assessment Service.
ResultsAmong 2,634 patients treated using clipping and coiling, 1,544 (58.6%) and 1,090 (41.4%) were hospitalized in high- and low-volume hospitals, respectively, and 910 (34.5%) and 1,724 (65.5%) were treated with clipping and coiling, respectively. Mortality rates were 13.5, 14.4, 15.2, and 16.1% at 3 months, 1, 2, and 4 years, respectively. High-volume hospitals had a significantly lower 3-month mortality rate. Patients with mild clinical status had a significantly lower 3-month mortality rate in high-volume hospitals than in low-volume hospitals. Patients with severe clinical status had significantly lower 1- and 2-year mortality rates in high-volume hospitals than in low-volume hospitals.
ConclusionShort- and long-term mortality in patients with SAH differed according to hospital volume. In the modern endovascular era, clipping and coiling can lead to better outcomes in facilities with high stroke-care capabilities.

引言 近年来，蛛网膜下腔出血（subarachnoid hemorrhage, SAH）的治疗手段持续优化，患者死亡率已有所下降，但蛛网膜下腔出血的诊疗结局仍受多种其他因素影响。本研究依托全国性大规模观察性数据，旨在探究蛛网膜下腔出血治疗后的短期与远期死亡率，以及患者病情严重程度与医院诊疗量的关联影响。
患者与方法 本研究从韩国急性卒中评估登记库（South Korean Acute Stroke Assessment Registry）中筛选接受动脉瘤夹闭术（clipping）与血管内弹簧圈栓塞术（coiling）治疗的蛛网膜下腔出血患者。其中，年完成夹闭术与栓塞术总手术量≥20例的医院定义为高诊疗量医院，年手术量<20例者为低诊疗量医院。本研究通过韩国健康保险审查与评估院（Health Insurance Review and Assessment Service）的数据库追踪患者的短期与远期死亡率。
研究结果 本研究共纳入2634例接受夹闭术与栓塞术治疗的蛛网膜下腔出血患者，其中1544例（58.6%）就诊于高诊疗量医院，1090例（41.4%）就诊于低诊疗量医院；分别有910例（34.5%）、1724例（65.5%）接受夹闭术、栓塞术治疗。患者术后3个月、1年、2年及4年的死亡率分别为13.5%、14.4%、15.2%及16.1%。高诊疗量医院患者的术后3个月死亡率显著更低。在病情较轻的患者亚组中，高诊疗量医院的患者术后3个月死亡率显著低于低诊疗量医院；在病情危重的患者亚组中，高诊疗量医院的患者术后1年、2年死亡率显著低于低诊疗量医院。
结论 蛛网膜下腔出血患者的短期与远期死亡率随医院诊疗量水平存在显著差异。在当代血管内治疗时代，具备高水平卒中诊疗能力的医疗机构开展夹闭术与栓塞术，可使患者获得更优的诊疗结局。