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. 2024 Nov;67(6):622-636.
doi: 10.3340/jkns.2023.0205. Epub 2024 Mar 4.

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

Sang-Won Park  1 , James Jisu Han  2 , Nam Hun Heo  3 , Eun Chae Lee  1 , Dong-Hun Lee  1 , Ji Young Lee  1 , Boung Chul Lee  4 , Young Wha Lim  4 , Gui Ok Kim  4 , Jae Sang Oh  1
Affiliations

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

Sang-Won Park et al. J Korean Neurosurg Soc. 2024 Nov.

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.

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Conflict of interest statement

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
flow chart of study population and patients included in linear model of longitudinal changes in hospital volume. ICH : intracerebral hemorrhage.
Fig. 2.
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.
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.
See this image and copyright information in PMC

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