University of Cambridge, Cambridge CB1 8RN, UK.
Stroke. 2013 Mar;44(3):647-52. doi: 10.1161/STROKEAHA.112.681254. Epub 2013 Jan 29.
Procedures requiring specific skill sets often have been shown to depend on institutional volume, that is, centers receiving a higher volume observe better outcomes in those patients. This relationship recently has been shown to exist for subarachnoid hemorrhage(SAH) patients in a large study in the United States. We aim to examine this relationship for SAH patients in England, restricting analysis to specialist neurosurgical units.
Aggregate counts of patients with SAH in 25 specialist neuroscience centers in England, from 2005 to 2011, were obtained from the Hospital Episode Statistics database maintained by the National Health Service Information Center. These data were linked with national mortality statistics to obtain counts of deaths. Poisson regression was used to investigate the relationship between institutional caseload of SAH and 6-month mortality from any cause. Six-month mortality rates and mortality ratios were computed.
Annual institutional caseload of admissions with SAH was inversely related to 6-month mortality (P=0.009; r(2)=0.26). Each 100-patient increase in annual patient volume was associated with a 24% reduction in mortality (adjusted mortality ratio, 0.76; confidence interval, 0.67-0.87). This relationship was consistent across the entire range of annual institutional caseloads examined (29-367 cases for the lowest and highest volumes seen in a single center in 1 year).
Our results provide support for management of SAH at high-volume centers and suggest that health care policy in this setting should pursue regionalization while ensuring an adequate geographic spread of access to care.
具有特定技能要求的程序通常依赖于机构数量，即接收更高数量患者的中心在这些患者中观察到更好的结果。最近在美国的一项大型研究中已经证明了蛛网膜下腔出血（SAH）患者存在这种关系。我们旨在检查英国 SAH 患者的这种关系，将分析仅限于专门的神经外科单位。
从国家卫生服务信息中心维护的医院住院统计数据库中获得了 2005 年至 2011 年英格兰 25 个专门神经科学中心的 SAH 患者的总计计数。这些数据与国家死亡率统计数据相关联，以获得任何原因导致的死亡计数。使用泊松回归来研究机构 SAH 病例量与任何原因导致的 6 个月死亡率之间的关系。计算了 6 个月死亡率和死亡率比。
每年机构 SAH 入院人数与 6 个月死亡率呈负相关（P=0.009；r²=0.26）。每年患者人数增加 100 人，死亡率降低 24%（调整后的死亡率比，0.76；置信区间，0.67-0.87）。这种关系在整个年度机构病例量范围内都是一致的（最低和最高年度单中心病例量分别为 29 例和 367 例）。
我们的结果为在高容量中心管理 SAH 提供了支持，并表明在这种情况下，医疗保健政策应在确保获得护理的地理分布足够的情况下追求区域化。
