High-Volume Hospital Had Lower Mortality of Severe Intracerebral Hemorrhage Patients

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: Cerebral hemorrhage; High-volume; Hospitals; Mortality.

Fig. 1.

flow chart of study population and patients included in linear model of longitudinal changes in hospital volume. ICH : intracerebral hemorrhage.

Fig. 2.

Kaplan-Meier estimates for survival probability based on specific conditions of intracerebral hemorrhage patients. A : Total patients stratified by surgery status. B : Total patients stratified by disease severity. C : Patients with mild clinical status stratified by surgery status. D : Patients with severe clinical status stratified by surgery status. E : Total patients stratified by age groups. F : Total patients stratified by sex.

Fig. 3.

Kaplan-Meier estimate for survival probability based on specific conditions of intracerebral hemorrhage patients according to hospital volume. A : Total patients according to hospital type. B : Total patients undergo surgery according to hospital type. C : Total patients did not undergo surgery according to hospital type. D : Mild clinical status according to hospital type. E : Severe clinical status according to hospital type.