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

¹Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
²Department of Molecular Biophysics and Biochemistry, Yale University, CITY, STATE, USA
³Department of Neurosurgery, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
⁴Health Insurance Review & Assessment Service (HIRA), Wonju, Korea

Correspondence

Jae Sang Oh ,Tel: +82-2, Fax: +82-2, Email: metatron1324@hotmail.com

Received: September 27, 2023; Revised: February 13, 2024 Accepted: February 27, 2024. Published online: March 4, 2024.
*Sang-Won Park and James Jisu Han contributed equally to this work.

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 9,086 ICH patients who admitted to hospital during 18-month period, 6,756 (74.4%) and 2,330 (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.

Key Words: Intracerebral hemorrhage · Long-term outcome · Mortality · Hospital volume