Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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High-Volume Hospital Had Lower Mortality of Severe Intracerebral Hemorrhage Patients

  • Sang-Won Park (Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • James Jisu Han (Department of Molecular Biophysics and Biochemistry, Yale University) ;
  • Nam Hun Heo (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University) ;
  • Eun Chae Lee (Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dong-Hun Lee (Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ji Young Lee (Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Boung Chul Lee (Health Insurance Review & Assessment Service (HIRA)) ;
  • Young Wha Lim (Health Insurance Review & Assessment Service (HIRA)) ;
  • Gui Ok Kim (Health Insurance Review & Assessment Service (HIRA)) ;
  • Jae Sang Oh (Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2023.09.27
  • Accepted : 2024.02.27
  • Published : 2024.11.01
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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.

Keywords

Acknowledgement

This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number : HC22C0043) by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government (2023RA1A2C100531). The authors wish to acknowledge the financial support of The Catholic University of Korea Uijeongbu St. Mary's Hospital Clinical Research Laboratory Foundation and Korea Neuroendovascular Society. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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