Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: A nationwide study in Japan (J-ASPECT Study)

Ryota Kurogi, Akiko Kada, Kunihiro Nishimura, Satoru Kamitani, Ataru Nishimura, Tetsuro Sayama, Jyoji Nakagawara, Kazunori Toyoda, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Shinya Matsuda, Shinichi Yoshimura, Kazuo Okuchi, Akifumi Suzuki, Fumiaki Nakamura, Daisuke OnozukaAkihito Hagihara, Koji Iihara

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish
Pages (from-to)1318-1326
Number of pages9
JournalJournal of Neurosurgery
Volume128
Issue number5
DOIs
Publication statusPublished - May 2018

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Subarachnoid Hemorrhage
Japan
Length of Stay
Hospital Mortality
Stroke
Costs and Cost Analysis
Therapeutics
Cerebral Infarction
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage : A nationwide study in Japan (J-ASPECT Study). / Kurogi, Ryota; Kada, Akiko; Nishimura, Kunihiro; Kamitani, Satoru; Nishimura, Ataru; Sayama, Tetsuro; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Yoshimura, Shinichi; Okuchi, Kazuo; Suzuki, Akifumi; Nakamura, Fumiaki; Onozuka, Daisuke; Hagihara, Akihito; Iihara, Koji.

In: Journal of Neurosurgery, Vol. 128, No. 5, 05.2018, p. 1318-1326.

Research output: Contribution to journalArticle

Kurogi, R, Kada, A, Nishimura, K, Kamitani, S, Nishimura, A, Sayama, T, Nakagawara, J, Toyoda, K, Ogasawara, K, Ono, J, Shiokawa, Y, Aruga, T, Miyachi, S, Nagata, I, Matsuda, S, Yoshimura, S, Okuchi, K, Suzuki, A, Nakamura, F, Onozuka, D, Hagihara, A & Iihara, K 2018, 'Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: A nationwide study in Japan (J-ASPECT Study)', Journal of Neurosurgery, vol. 128, no. 5, pp. 1318-1326. https://doi.org/10.3171/2016.12.JNS161039
Kurogi, Ryota ; Kada, Akiko ; Nishimura, Kunihiro ; Kamitani, Satoru ; Nishimura, Ataru ; Sayama, Tetsuro ; Nakagawara, Jyoji ; Toyoda, Kazunori ; Ogasawara, Kuniaki ; Ono, Junichi ; Shiokawa, Yoshiaki ; Aruga, Toru ; Miyachi, Shigeru ; Nagata, Izumi ; Matsuda, Shinya ; Yoshimura, Shinichi ; Okuchi, Kazuo ; Suzuki, Akifumi ; Nakamura, Fumiaki ; Onozuka, Daisuke ; Hagihara, Akihito ; Iihara, Koji. / Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage : A nationwide study in Japan (J-ASPECT Study). In: Journal of Neurosurgery. 2018 ; Vol. 128, No. 5. pp. 1318-1326.
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abstract = "OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.",
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T1 - Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage

T2 - A nationwide study in Japan (J-ASPECT Study)

AU - Kurogi, Ryota

AU - Kada, Akiko

AU - Nishimura, Kunihiro

AU - Kamitani, Satoru

AU - Nishimura, Ataru

AU - Sayama, Tetsuro

AU - Nakagawara, Jyoji

AU - Toyoda, Kazunori

AU - Ogasawara, Kuniaki

AU - Ono, Junichi

AU - Shiokawa, Yoshiaki

AU - Aruga, Toru

AU - Miyachi, Shigeru

AU - Nagata, Izumi

AU - Matsuda, Shinya

AU - Yoshimura, Shinichi

AU - Okuchi, Kazuo

AU - Suzuki, Akifumi

AU - Nakamura, Fumiaki

AU - Onozuka, Daisuke

AU - Hagihara, Akihito

AU - Iihara, Koji

PY - 2018/5

Y1 - 2018/5

N2 - OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

AB - OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

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