Variability in Outcome After Elective Cerebral Aneurysm Repair in High-Volume Academic Medical Centers
| العنوان: | Variability in Outcome After Elective Cerebral Aneurysm Repair in High-Volume Academic Medical Centers |
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| المؤلفون: | Amanda M. Carpenter, June Lu, Brad E. Zacharia, Catherine Richards, Robert A. Solomon, Geoffrey Appelboom, E. Sander Connolly, Samuel S. Bruce, Kerry A. Vaughan, William Gold, Zachary L. Hickman |
| المصدر: | Stroke. 45:1447-1452 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Adult, Male, Microsurgery, medicine.medical_specialty, New York, Logistic regression, Outcome (game theory), Tertiary Care Centers, Aneurysm, Outcome Assessment, Health Care, medicine, Performed Procedure, Humans, Good outcome, Stroke, Advanced and Specialized Nursing, Academic Medical Centers, business.industry, Endovascular Procedures, Intracranial Aneurysm, medicine.disease, Surgery, Patient Outcome Assessment, Logistic Models, Elective Surgical Procedures, Emergency medicine, Female, Neurology (clinical), Neurosurgery, Principal diagnosis, Cardiology and Cardiovascular Medicine, business |
| الوصف: | Background and Purpose— Unruptured intracranial aneurysm repair is the most commonly performed procedure for the prevention of hemorrhagic stroke. Despite efforts to regionalize care in high-volume centers, overall results have improved little. This study aims to determine the effectiveness in improving outcomes of previous efforts to regionalize unruptured intracranial aneurysm repair to high-volume centers and to recommend future steps toward that goal. Methods— Using data obtained via the New York Statewide Planning and Research Cooperative System, this study included all patients admitted to any of the 10 highest volume centers in New York state between 2005 and 2010 with a principal diagnosis of unruptured intracranial aneurysm who were treated either by microsurgical or endovascular repair. Mixed-effects logistic regression was used to determine the degree to which hospital-level and patient-level variables contributed to observed variation in good outcome, defined as discharge to home, between hospitals. Results— Of 3499 patients treated during the study period, 2692 (76.9%) were treated at the 10 highest volume centers, with 2198 (81.6%) experiencing a good outcome. Good outcomes varied widely between centers, with 44.6% to 91.1% of clipped patients and 75.4% to 92.1% of coiled patients discharged home. Mixed-effects logistic regression revealed that procedural volume accounts for 85.8% of the between-hospital variation in outcome. Conclusions— There is notable interhospital heterogeneity in outcomes among even the largest volume unruptured intracranial aneurysm referral centers. Although further regionalization may be needed, mandatory participation in prospective, adjudicated registries will be necessary to reliably identify factors associated with superior outcomes. |
| تدمد: | 1524-4628 0039-2499 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::70369501dbf85e8671e700d8ec2148c6Test https://doi.org/10.1161/strokeaha.113.004412Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....70369501dbf85e8671e700d8ec2148c6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15244628 00392499 |
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