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Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)
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- Satoru Kamitani
- Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo;
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- Tetsuro Sayama
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka;
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- Shigeru Miyachi
- Department of Neurosurgery, Osaka Medical College, Takatsuki;
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- Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka;
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- Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University, Mitaka;
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- Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka;
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- Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita;
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- Jyoji Nakagawara
- Integrative Stroke Imaging Centre;
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- Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka;
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- Toru Aruga
- Department of Emergency and Critical Care Medicine, Showa University Hospital, Shinagawa;
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- Junichi Ono
- Department of Neurosurgery, Chiba Cerebral and Cardiovascular Centre, Chiba;
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- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita;
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- Akiko Kada
- Department of Clinical Trials and Research, National Hospital Organization Nagoya Medical Centre, Nagoya;
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- Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu;
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- Daisuke Onozuka
- Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Fumiaki Nakamura
- Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo;
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- Akifumi Suzuki
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita; and
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- Akihito Hagihara
- Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara;
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- Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka;
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- Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu;
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- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya;
Bibliographic Information
- Published
- 2018-05
- Resource Type
- journal article
- DOI
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- 10.3171/2016.12.jns161039
- Publisher
- Journal of Neurosurgery Publishing Group (JNSPG)
Search this article
Description
<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Although heterogeneity in patient outcomes following subarachnoid hemorrhage (SAH) has been observed across different centers, the relative merits of clipping and coiling for SAH remain unknown. The authors sought to compare the patient outcomes between these therapeutic modalities using a large nationwide discharge database encompassing hospitals with different comprehensive stroke center (CSC) capabilities.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>They analyzed data from 5214 patients with SAH (clipping 3624, coiling 1590) who had been urgently hospitalized at 393 institutions in Japan in the period from April 2012 to March 2013. In-hospital mortality, modified Rankin Scale (mRS) score, cerebral infarction, complications, hospital length of stay, and medical costs were compared between the clipping and coiling groups after adjustment for patient-level and hospital-level characteristics by using mixed-model analysis.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Patients who had undergone coiling had significantly higher in-hospital mortality (12.4% vs 8.7%, OR 1.3) and a shorter median hospital stay (32.0 vs 37.0 days, p < 0.001) than those who had undergone clipping. The respective proportions of patients discharged with mRS scores of 3–6 (46.4% and 42.9%) and median medical costs (thousands US$, 35.7 and 36.7) were not significantly different between the groups. These results remained robust after further adjustment for CSC capabilities as a hospital-related covariate.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Despite the increasing use of coiling, clipping remains the mainstay treatment for SAH. Regardless of CSC capabilities, clipping was associated with reduced in-hospital mortality, similar unfavorable functional outcomes and medical costs, and a longer hospital stay as compared with coiling in 2012 in Japan. Further study is required to determine the influence of unmeasured confounders.</jats:p></jats:sec>
Journal
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- Journal of Neurosurgery
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Journal of Neurosurgery 128 (5), 1318-1326, 2018-05
Journal of Neurosurgery Publishing Group (JNSPG)
