National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Ryota Kurogi, Akiko Kada, Kuniaki Ogasawara, Kunihiro Nishimura, Takanari Kitazono, Toru Iwama, Yuji Matsumaru, Nobuyuki Sakai, Yoshiaki Shiokawa, Shigeru Miyachi, Satoshi Kuroda, Hiroaki Shimizu, Shinichi Yoshimura, Toshiaki Osato, Nobutaka Horie, Izumi Nagata, Kazuhiko Nozaki, Isao Date, Yoichiro Hashimoto, Haruhiko HoshinoHiroyuki Nakase, Hiroharu Kataoka, Tsuyoshi Ohta, Hitoshi Fukuda, Nanako Tamiya, A. I. Kurogi, Nice Ren, Ataru Nishimura, Koichi Arimura, Takafumi Shimogawa, Koji Yoshimoto, Daisuke Onozuka, Soshiro Ogata, Akihito Hagihara, Nobuhito Saito, Hajime Arai, Susumu Miyamoto, Teiji Tominaga, Koji Iihara

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. Design Retrospective study. Setting Six hundred and thirty-one primary care institutions in Japan. Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

Original languageEnglish
Article numbere068642
JournalBMJ Open
Volume13
Issue number4
DOIs
Publication statusPublished - 10-04-2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • General Medicine

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