Temporal Trends and Practice Variation in Early Repair of the Ruptured Aneurysm Among Patients with Aneurysmal Subarachnoid Hemorrhage in the United States, 2012-2019

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-09-10 DOI:10.1177/17474930241285728
wei chen, Jing Chen, Dong Li
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Abstract

Background: Early repair of the ruptured cerebral aneurysm (RRCA), preferably within 24 hours of onset, is endorsed by clinical guideline as the preferred management strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, a comprehensive picture of this guideline-recommended usage in contemporary clinical practice is not available.Aims: This study aimed to characterize trends over time and practice variation in the implementation of an early RRCA strategy among patients with aSAH in a large, national representative data.Methods: Using data from the 2012-2019 National Inpatient Sample, we measured trends in the proportion of early RRCA, defined as within day 1 of admission, overall, and by demographic and geographical subgroups. Additionally, we created multilevel regression models to quantify hospital-level variation in the early RRCA rates.Results: We identified 82,615 aSAH hospitalizations (mean age, 56.1 years; 68.9% women) undergoing RRCA and, among these, 84.0% (95% CI, 83.4-84.7%) receiving early RRCA. The proportion of early RRCA increased steadily from 82.5% in 2012 to 85.8% in 2019 (P for trend <0.001). The proportion of patients receiving early RRCA across geographic regions ranged from 78.7% to 87.9%, with a median (IQR) of 84.2% (83.0-86.1%). In contrast, the delivery of early RRCA varied widely among hospitals, with a median (IQR) rate of 86.1% (75.0-100.0%) and a range from 0 to 100.0%. The median odds ratio for the early use of RRCA treatment was 1.24 (95% CI, 1.21-1.27) in 2019, indicating 24% increased odds of implementing early RRCA if moving from a lower-use to a higher-use hospital.Conclusions: Most patients in the United States with aSAH received early RRCA treatment and exhibited an upward trend over the recent 8-year period. However, substantial variation in access to early RRCA was been observed across population subgroups, particularly at the hospital level. Future efforts are necessary to identify further sources of this variation and to develop initiatives that could represent an opportunity to optimize guideline-based quality of care in aSAH management.
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2012-2019 年美国动脉瘤性蛛网膜下腔出血患者早期修复破裂动脉瘤的时间趋势和实践差异
背景:临床指南将动脉瘤性蛛网膜下腔出血(aSAH)患者的首选治疗策略定为早期修复破裂的脑动脉瘤(RRCA),最好在发病 24 小时内进行修复。目的:本研究旨在通过具有全国代表性的大型数据,描述动脉瘤性蛛网膜下腔出血(aSAH)患者实施早期 RRCA 策略的长期趋势和实践差异:利用 2012-2019 年全国住院患者样本数据,我们测量了早期 RRCA(定义为入院第 1 天内)比例的总体趋势,以及不同人口和地域亚群的趋势。此外,我们还创建了多层次回归模型,以量化早期 RRCA 比例在医院层面的变化:我们发现有 82,615 例 aSAH 住院患者(平均年龄 56.1 岁;68.9% 为女性)接受了 RRCA,其中 84.0%(95% CI,83.4-84.7%)的患者接受了早期 RRCA。早期 RRCA 的比例从 2012 年的 82.5% 稳步上升至 2019 年的 85.8%(趋势 P <0.001)。各地区接受早期 RRCA 的患者比例从 78.7% 到 87.9% 不等,中位数(IQR)为 84.2% (83.0-86.1%)。相比之下,各医院早期 RRCA 的实施情况差异很大,中位数(IQR)为 86.1%(75.0-100.0%),范围从 0 到 100.0%。2019年早期使用RRCA治疗的中位几率比为1.24(95% CI,1.21-1.27),表明如果从使用率较低的医院转到使用率较高的医院,实施早期RRCA的几率会增加24%:结论:在美国,大多数ASAH患者都接受了早期RRCA治疗,并且在最近8年中呈上升趋势。然而,在不同的人群亚群中,特别是在医院层面,早期 RRCA 的获得情况存在很大差异。我们有必要在今后的工作中进一步确定造成这种差异的原因,并制定相关措施,以优化以指南为基础的 aSAH 治疗质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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