title: Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes.
abstract: OBJECTIVE
  To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners.
  
  
  METHODS
  Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents.
  
  
  RESULTS
  A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%).
  
  
  CONCLUSIONS
  The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
authors: Departments of Neurosurgery and Neurology, University of Texas Medical School, Houston, TX. Electronic address: Tiffany.R.Chang@uth.tmc.edu.
authors: Tiffany R
authors: TR
authors: Chang
authors: Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rkowalski@gmail.com.
authors: Robert G
authors: RG
authors: Kowalski
authors: Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jcarhua1@jhmi.edu.
authors: J Ricardo
authors: JR
authors: Carhuapoma
authors: Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rtamarg@jhmi.edu.
authors: Rafael J
authors: RJ
authors: Tamargo
authors: Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: nnaval1@jhmi.edu.
authors: Neeraj S
authors: NS
authors: Naval
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality*; D016896:Treatment Outcome
keywords: Aneurysm; Case volume; Caseload; Neurocritical care unit; Outcome; Subarachnoid hemorrhage