title: Hospital case volume is associated with mortality in patients hospitalized with subarachnoid hemorrhage.
abstract: BACKGROUND
  Prior studies have suggested that hospital case volume may be associated with improved outcomes after subarachnoid hemorrhage (SAH), but contemporary national data are limited.
  
  
  OBJECTIVE
  To assess the association between hospital case volume for SAH and in-hospital mortality.
  
  
  METHODS
  Using the Get With The Guidelines-Stroke registry, we analyzed patients with a discharge diagnosis of SAH between April 2003 and March 2012. We assessed the association of annual SAH case volume with in-hospital mortality by using multivariable logistic regression adjusting for relevant patient, hospital, and geographic characteristics.
  
  
  RESULTS
  Among 31,973 patients with SAH from 685 hospitals, the median annual case volume per hospital was 8.5 (25th-75th percentile, 6.7-12.9) patients. Mean in-hospital mortality was 25.7%, but was lower with increasing annual SAH volume: 29.5% in quartile 1 (range, 4-6.6), 27.0% in quartile 2 (range, 6.7-8.5), 24.1% in quartile 3 (range, 8.5-12.7), and 22.1% in quartile 4 (range, 12.9-94.5). Adjusting for patient and hospital characteristics, hospital SAH volume was independently associated with in-hospital mortality (adjusted odds ratio 0.79 for quartile 4 vs 1, 95% confidence interval, 0.67-0.92). The quartile of SAH volume also was associated with length of stay but not with discharge home or independent ambulatory status.
  
  
  CONCLUSIONS
  In a large nationwide registry, we observed that patients treated at hospitals with higher volumes of SAH patients have lower in-hospital mortality, independent of patient and hospital characteristics. Our data suggest that experienced centers may provide more optimized care for SAH patients.
authors: *Department of Neurology, Northwestern University, Chicago, Illinois; ‡Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California; §Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; ¶Duke Clinical Research Institute, Durham, North Carolina; and ‖Division of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Shyam
authors: S
authors: Prabhakaran
authors: Gregg C
authors: GC
authors: Fonarow
authors: Eric E
authors: EE
authors: Smith
authors: Li
authors: L
authors: Liang
authors: Ying
authors: Y
authors: Xian
authors: Megan
authors: M
authors: Neely
authors: Eric D
authors: ED
authors: Peterson
authors: Lee H
authors: LH
authors: Schwamm
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012042:Registries; D013345:Subarachnoid Hemorrhage / Q000401:mortality*