TY - JOUR
T1 - Hospital volume and 1-year mortality after treatment of intracranial aneurysms
T2 - A study based on patient registries in Scandinavia
AU - Lindekleiv, Haakon
AU - Mathiesen, Ellisiv B.
AU - Førde, Olav H.
AU - Wilsgaard, Tom
AU - Ingebrigtsen, Tor
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Object The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms. Methods The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment). Results The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00-1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42-1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01). Conclusions The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.
AB - Object The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms. Methods The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment). Results The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00-1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42-1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01). Conclusions The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.
KW - Endovascular treatment
KW - Hospital volume
KW - Intracranial aneurysm
KW - Rupture
KW - Scandinavia
KW - Surgery
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=84952717083&partnerID=8YFLogxK
U2 - 10.3171/2014.12.JNS142106
DO - 10.3171/2014.12.JNS142106
M3 - Article
C2 - 26162040
AN - SCOPUS:84952717083
SN - 0022-3085
VL - 123
SP - 631
EP - 637
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 3
ER -