Case Volume Does Not Correlate With Outcome After Cerebral Aneurysm Clipping: A Nationwide Study in Japan

Hattori, Naoyuki; Katayama, Yoichi; Abe, Takumi

doi:10.2176/nmc.47.95

Cited by 40 publications

(39 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lower mortality in high-volume hospitals may therefore have been confounded, for instance, by differences in length of stay and discharge routines. [1][2][3][4]7,8,[12][13][14]16,18 Furthermore, all previous studies except 2 originated in the US and the analyses include data from hospitals where multidisciplinary neurosurgical care is likely to be less available or absent. [1][2][3][4]7,8,13,14,16,18 Results from these studies may not be generalizable to health care systems in other countries where specialist neurosurgical services are centralized to tertiary regional hospitals with a defined population and patients are referred from smaller hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…12,17 One study from Japan found no relationship between hospital volume and functional outcome (Glasgow Outcome Scale score) at discharge after treatment of ruptured and unruptured intracranial aneurysms. 12 One study from the United Kingdom examined the relationship between hospital volume and 6-month mortality after (aneurysmal and nonaneurysmal) SAH.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4]7,8,[12][13][14]16,18 Data collection on the relationship between hospital volume and long-term mortality is highly warranted. This topic is of increasing interest as open surgeries for intracranial aneurysms are being replaced by endovascular procedures.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

Lindekleiv¹,

Mathiesen

Førde³

et al. 2015

JNS

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

Lindekleiv¹,

Mathiesen

Førde³

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…The outcomes at discharge and six months post-surgery were assessed by using the modified Rankin's Scale (mRS score 0-6, Table 2). A dichotomised mRS score, based on other aneurysm studies (3,6,7), was used as a clinical outcome measurement for patients post clipping. The mRS scores of 0 to 2 were grouped into the "favourable" and mRS scores of 3 to 6 were grouped into the "unfavourable" categories.…”

Section: Methodsmentioning

confidence: 99%

The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm

Chee¹,

Siregar²,

Ghani³

et al. 2018

MJMS

View full text Add to dashboard Cite

Failure to diagnose, delay in admission to a neurosurgical centre, and lack of facilities could have led to the poor surgical outcome in these patients. The purpose of this study is to identify the factors that significantly predict the outcome of patients undergoing a surgical clipping of ruptured aneurysm in the local population.Material and Method: A single center retrospective study with a review of medical records was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms in the Sultanah Aminah Hospital, in Johor Bahru, from July 2011 to January 2016. Information collected was the patient demographic data, Glasgow Coma Scale (GCS) prior to surgery, World Federation of Neurosurgical Societies Scale (WFNS), subarachnoid hemorrhage (SAH) grading system, and timing between SAH ictus and surgery. A good clinical grade was defined as WFNS grade I-III, whereas, WFNS grades IV and V were considered to be poor grades. The outcomes at discharge and six months post surgery were assessed using the modified Rankin's Scale (mRS). The mRS scores of 0 to 2 were grouped into the "favourable" category and mRS scores of 3 to 6 were grouped into the "unfavourable" category. Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected was analysed using the Statistical Package for Social Sciences (SPSS). Univariate and multivariate analyses were performed and a P-value of < 0.05 was considered to be statistically significant.Result: A total of 105 patients were included. The group was comprised of 42.9% male and 57.1% female patients. The mean GCS of the patients subjected to surgical clipping was 13, with the majority falling into the good clinical grade (78.1%). The mean timing of the surgery after SAH was 5.3 days and this was further categorised into early (day one to day three, 45.3%), intermediate (day four to day ten, 56.2%), and late (after day ten, 9.5%). The total favourable outcome achieved at discharge was 59.0% as compared to 41.0% of the unfavourable outcome, with an overall mortality rate of 10.5%. At the six-month post surgery review (n = 94), the patients with a favourable outcome constituted 71.3% as compared to 28.7% with an unfavourable outcome. The mortality, six months post surgery was 3.2%. On a univariate analysis of early surgical clipping, patients with a better GCS and good clinical grade had a significantly better outcome at MethodologyA single centre retrospective study with review of case notes was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms from July 2011 until January 2016. Information collected included, the patient demographics, presenting symptoms, Glasgow Coma Scale (GCS) prior to surgery, timing between SAH ictus and surgery, duration of surgery, location of aneurysm, and maximum size of the aneurysm. A patient's preoperative neurological condition was classified using the World Federation of Neurosurg...

show abstract

“…Survey of the outcomes of aneurysm surgery in Japan found the surgical mortality of 4,396 UIAs was 0.2%. 7) The case volume of the institution did not affect the surgical outcome in this survey. Quality of life (QOL) score was also analyzed in several outcome studies.…”

Section: Management Outcome and Risksmentioning

confidence: 63%

Unruptured Intracranial Aneurysms: Current Perspectives on the Origin and Natural Course, and Quest for Standards in the Management Strategy

Morita

Kimura

Shojima

et al. 2010

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Unruptured intracranial aneurysms are relatively common, and can cause subarachnoid hemorrhage. Management of unruptured intracranial aneurysms requires knowledge of the natural course and management risks of individual aneurysms. Current knowledge on the natural course and management risks is summarized and our current management strategy presented. Extensive literature review was conducted to identify risk factors influencing the natural course and management outcome of unruptured intracranial aneurysms. Our consecutive surgical series from October 2006 through June 2009 were reviewed retrospectively. The risk factors for rupture were size and location, as well as history of subarachnoid hemorrhage in small aneurysms. Management morbidity was significantly influenced by the size, location, and patient's age. Since 2006, we have monitored motor evoked potentials in all surgeries of cerebral aneurysms and utilized endoscope control, and skull base and bypass techniques in selected cases. In 133 consecutive surgeries, two patients (1.5%) suffered severe neurological morbidity. Unruptured intracranial aneurysms have various clinical characteristics and we need to stratify management strategy according to the aneurysm features such as size, location, shape, and patient's clinical status. In Japan, with national efforts to elevate management standards, morbidity associated with the treatment of the unruptured intracranial aneurysms is relatively low. To improve future care further, we need to continue seeking better and less invasive management modalities and technique.

show abstract

Case Volume Does Not Correlate With Outcome After Cerebral Aneurysm Clipping: A Nationwide Study in Japan

Cited by 40 publications

References 22 publications

Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm

Unruptured Intracranial Aneurysms: Current Perspectives on the Origin and Natural Course, and Quest for Standards in the Management Strategy

Contact Info

Product

Resources

About