National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study.
Neurosurgery
VASCULAR SURGERY
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
10 04 2023
10 04 2023
Historique:
medline:
12
4
2023
entrez:
10
4
2023
pubmed:
11
4
2023
Statut:
epublish
Résumé
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. Retrospective study. Six hundred and thirty-one primary care institutions in Japan. Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. 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). 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. 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.
Identifiants
pubmed: 37037619
pii: bmjopen-2022-068642
doi: 10.1136/bmjopen-2022-068642
pmc: PMC10111904
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e068642Investigateurs
Hidekazu Takahashi
(H)
Isao Sasaki
(I)
Kazuo Kitazawa
(K)
Minoru Saitoh
(M)
Hitoshi Saito
(H)
Hiroaki Shimizu
(H)
Minoru Asahi
(M)
Makoto Goda
(M)
Atsuhito Takemura
(A)
Tatsuya Sasaki
(T)
Masaaki Shibukawa
(M)
Isao Fuwa
(I)
Saburo Watanabe
(S)
Seiko Kataoka
(S)
Koji Takasaki
(K)
Kouji Shiga
(K)
Kensuke Hayashida
(K)
Hidefuku Gi
(H)
Ryunosuke Uranishi
(R)
Toshihiko Iuchi
(T)
Junichi Ono
(J)
Chiaki Ito
(C)
Kenji Wakui
(K)
Takashi Saegusa
(T)
Isao Kitahara
(I)
Yasushi Ejima
(Y)
Hiroshi Tanaka
(H)
Satoru Hayashi
(S)
Kazuyoshi Hattori
(K)
Shinji Okita
(S)
Toshikazu Ichihashi
(T)
Tsugumichi Ichioka
(T)
Shinichi Shirakami
(S)
Takeshi Matsuoka
(T)
Akio Hyodo
(A)
Teruo Kimura
(T)
Tomonori Kobayashi
(T)
Kanehisa Kohno
(K)
Kazunori Yamanaka
(K)
Akira Morooka
(A)
Nozomi Mori
(N)
Hideo Kunimine
(H)
Kazutaka Yatsushiro
(K)
Masahiro Satoh
(M)
Ichiro Nakahara
(I)
Syougo Imae
(S)
Hirochiyo Wada
(H)
Mamoru Murakami
(M)
Masanori Kabuto
(M)
Katsuyuki Hirakawa
(K)
Isao Inoue
(I)
Hidenori Yoshida
(H)
Kiyoshi Kazekawa
(K)
Masani Nonaka
(M)
Kouzou Fukuyama
(K)
Shigenari Kin
(S)
Kiyoshi Saito
(K)
Yoichi Watanabe
(Y)
Tadashi Arisawa
(T)
Kou Takahashi
(K)
Tetsuya Tanigawara
(T)
Junki Ito
(J)
Toru Iwama
(T)
Kei Hisada
(K)
Makoto Takeda
(M)
Jun Niwa
(J)
Mikio Nishiya
(M)
Shuji Hayashi
(S)
Ichiro Fujishima
(I)
Teiji Nakayama
(T)
Yoshihiko Watanabe
(Y)
Koichirou Matsukado
(K)
Takamichi Yuguchi
(T)
Tadahisa Shono
(T)
Hiroyuki Nishimura
(H)
Jyunya Hayashi
(J)
Keisuke Migita
(K)
Kazuhiro Yokoyama
(K)
Naofumi Isono
(N)
Satoshi Utsuki
(S)
Hirotoshi Ohtaka
(H)
Takata Hisashi
(T)
Takamitsu Uchizawa
(T)
Hiroki Ohkuma
(H)
Shigeki Nishino
(S)
Atsushi Tominaga
(A)
Masayuki Sumida
(M)
Kaoru Kurisu
(K)
Naoki Shinohara
(N)
Kiyohiro Houkin
(K)
Mitsunobu Kaijima
(M)
Kazumi Nitta
(K)
Junkoh Yamamoto
(J)
Shinichi Yoshimura
(S)
Yoshio Sakagami
(Y)
Hideo Aihara
(H)
Takayuki Sakaki
(T)
Hiroko Oyama
(H)
Keishi Fujita
(K)
Sumio Kobayashi
(S)
Nobuaki Momozaki
(N)
Atsushi Sato
(A)
Hideki Murakami
(H)
Masahito Hara
(M)
Akazi Kazunori
(A)
Fumitaka Miya
(F)
Hisato Minamide
(H)
Tsuyoshi Inoue
(T)
Shinichiro Kurokawa
(S)
Syuichi Ishikawa
(S)
Naohisa Miura
(N)
Shinya Noda
(S)
Shoji Mashiyama
(S)
Shinji Amano
(S)
Kuniaki Ogasawara
(K)
Takayuki Sugawara
(T)
Yukihiko Shimizu
(Y)
Keiichi Saito
(K)
Kazuyuki Miura
(K)
Akinori Yabuta
(A)
Tatumi Yamanome
(T)
Hiroshi Seto
(H)
Makoto Hasebe
(M)
Hikaru Mizobuchi
(H)
Junkoh Sasaki
(J)
Shin Tsuruoka
(S)
Keiichi Nishimaki
(K)
Katsumi Takizawa
(K)
Hiroki Toda
(H)
Hitoshi Tsugu
(H)
Nozomi Suzuki
(N)
Takeshi Kohno
(T)
Shu Hasegawa
(S)
Ken Asakura
(K)
Ichiro Suzuki
(I)
Masaki Miyatake
(M)
Hiromu Konno
(H)
Katsunobu Takenaka
(K)
Akira Ikeda
(A)
Keizou Yamamoto
(K)
Yoshihiro Nishiura
(Y)
Keigo Matsumoto
(K)
Kazunari Koga
(K)
Satoshi Inoha
(S)
Masaki Morisige
(M)
Kunihiko Harada
(K)
Hirofumi Hiyama
(H)
Yasuaki Takeda
(Y)
Taturou Mori
(T)
Takekazu Akiyama
(T)
Osamu Okuda
(O)
Hajime Arai
(H)
Kazuaki Awamori
(K)
Naoki Shirasaki
(N)
Kimihiro Yoshino
(K)
Atsushi Shindo
(A)
Kazuho Hirahara
(K)
Shunichi Tanaka
(S)
Teruaki Kawano
(T)
Kazunori Arita
(K)
Hiroaki Sawaura
(H)
Hiromu Hadeishi
(H)
Yoichi Uozumi
(Y)
Masahiko Tanaka
(M)
Shunsuke Shiraga
(S)
Shuji Sato
(S)
Mitsutoshi Nakada
(M)
Kimihisa Kinoshita
(K)
Nakazawa Kazutomo
(N)
Yasuhiro Fujimoto
(Y)
Kunikazu Yoshimura
(K)
Masaaki Iwase
(M)
Shinichi Yagi
(S)
Atsushi Tsuchiya
(A)
Junichi Harashina
(J)
Akira Watanabe
(A)
Sadao Kaneko
(S)
Naoto Kuwayama
(N)
Junya Hayashi
(J)
Masaaki Uno
(M)
Masayuki Sasou
(M)
Sotaro Higashi
(S)
Kazunari Yoshida
(K)
Masakazu Kitahara
(M)
Satoshi Suzuki
(S)
Sumio Suda
(S)
Amami Kato
(A)
Yusaku Nakamura
(Y)
Satoshi Magarisawa
(S)
Kenji Hashimoto
(K)
Hiroyuki Matsumoto
(H)
Hirotoshi Hamaguchi
(H)
Tomohiko Satou
(T)
Masaru Idei
(M)
Haruhisa Tsukamoto
(H)
Eiichiro Kamatsuka
(E)
Toshihiro Kumabe
(T)
Naoaki Sato
(N)
Yasuyuki Toba
(Y)
Nobuyuki Sakai
(N)
Takashi Tominaga
(T)
Haruo Yamashita
(H)
Eiji Kohmura
(E)
Masanori Morimoto
(M)
Tetsuya Ueba
(T)
Toyoaki Shinohara
(T)
Kazuyoshi Watanabe
(K)
Hidenori Endo
(H)
Kenjirou Hujiwara
(K)
Kenjirou Hujiwara
(K)
Toshinori Hasegawa
(T)
Hisashi Nitta
(H)
Kuroyanagi Takayuki
(K)
Nobuhiko Mizutani
(N)
Akira Tsunoda
(A)
Fumio Suzuki
(F)
Tetsuya Morimoto
(T)
Takuya Kawai
(T)
Mitsuyuki Fujitsuka
(M)
Akira Takada
(A)
Hiromasa Tsuiki
(H)
Junichi Kuratsu
(J)
Masaki Chin
(M)
Hidemichi Sasayama
(H)
Shigehiro Ohmori
(S)
Seiko Hasegawa
(S)
Hidekazu Takahashi
(H)
Isao Sasaki
(I)
Kazuo Kitazawa
(K)
Minoru Saitoh
(M)
Hitoshi Saito
(H)
Hiroaki Shimizu
(H)
Minoru Asahi
(M)
Makoto Goda
(M)
Atsuhito Takemura
(A)
Tatsuya Sasaki
(T)
Masaaki Shibukawa
(M)
Isao Fuwa
(I)
Saburo Watanabe
(S)
Seiko Kataoka
(S)
Koji Takasaki
(K)
Kouji Shiga
(K)
Kensuke Hayashida
(K)
Hidefuku Gi
(H)
Ryunosuke Uranishi
(R)
Toshihiko Iuchi
(T)
Junichi Ono
(J)
Chiaki Ito
(C)
Kenji Wakui
(K)
Takashi Saegusa
(T)
Isao Kitahara
(I)
Yasushi Ejima
(Y)
Hiroshi Tanaka
(H)
Satoru Hayashi
(S)
Kazuyoshi Hattori
(K)
Shinji Okita
(S)
Toshikazu Ichihashi
(T)
Tsugumichi Ichioka
(T)
Shinichi Shirakami
(S)
Takeshi Matsuoka
(T)
Akio Hyodo
(A)
Teruo Kimura
(T)
Tomonori Kobayashi
(T)
Kanehisa Kohno
(K)
Kazunori Yamanaka
(K)
Akira Morooka
(A)
Nozomi Mori
(N)
Hideo Kunimine
(H)
Kazutaka Yatsushiro
(K)
Masahiro Satoh
(M)
Ichiro Nakahara
(I)
Syougo Imae
(S)
Hirochiyo Wada
(H)
Mamoru Murakami
(M)
Masanori Kabuto
(M)
Katsuyuki Hirakawa
(K)
Isao Inoue
(I)
Hidenori Yoshida
(H)
Kiyoshi Kazekawa
(K)
Masani Nonaka
(M)
Kouzou Fukuyama
(K)
Shigenari Kin
(S)
Kiyoshi Saito
(K)
Yoichi Watanabe
(Y)
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(T)
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(K)
Tetsuya Tanigawara
(T)
Junki Ito
(J)
Toru Iwama
(T)
Kei Hisada
(K)
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(M)
Jun Niwa
(J)
Mikio Nishiya
(M)
Shuji Hayashi
(S)
Ichiro Fujishima
(I)
Teiji Nakayama
(T)
Yoshihiko Watanabe
(Y)
Koichirou Matsukado
(K)
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(T)
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(T)
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(H)
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(J)
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(K)
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(K)
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(S)
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(H)
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(T)
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(T)
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(N)
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(K)
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(M)
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(K)
Junkoh Yamamoto
(J)
Shinichi Yoshimura
(S)
Yoshio Sakagami
(Y)
Hideo Aihara
(H)
Takayuki Sakaki
(T)
Hiroko Oyama
(H)
Keishi Fujita
(K)
Sumio Kobayashi
(S)
Nobuaki Momozaki
(N)
Atsushi Sato
(A)
Hideki Murakami
(H)
Masahito Hara
(M)
Akazi Kazunori
(A)
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(F)
Hisato Minamide
(H)
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(T)
Shinichiro Kurokawa
(S)
Syuichi Ishikawa
(S)
Naohisa Miura
(N)
Shinya Noda
(S)
Shoji Mashiyama
(S)
Shinji Amano
(S)
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(K)
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(T)
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(Y)
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(K)
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(K)
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(A)
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(T)
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(H)
Makoto Hasebe
(M)
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(H)
Junkoh Sasaki
(J)
Shin Tsuruoka
(S)
Keiichi Nishimaki
(K)
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(K)
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(H)
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(H)
Nozomi Suzuki
(N)
Takeshi Kohno
(T)
Shu Hasegawa
(S)
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(K)
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(I)
Masaki Miyatake
(M)
Hiromu Konno
(H)
Katsunobu Takenaka
(K)
Akira Ikeda
(A)
Keizou Yamamoto
(K)
Yoshihiro Nishiura
(Y)
Keigo Matsumoto
(K)
Kazunari Koga
(K)
Satoshi Inoha
(S)
Masaki Morisige
(M)
Kunihiko Harada
(K)
Hirofumi Hiyama
(H)
Yasuaki Takeda
(Y)
Taturou Mori
(T)
Takekazu Akiyama
(T)
Osamu Okuda
(O)
Hajime Arai
(H)
Kazuaki Awamori
(K)
Naoki Shirasaki
(N)
Kimihiro Yoshino
(K)
Atsushi Shindo
(A)
Kazuho Hirahara
(K)
Shunichi Tanaka
(S)
Teruaki Kawano
(T)
Kazunori Arita
(K)
Hiroaki Sawaura
(H)
Hiromu Hadeishi
(H)
Yoichi Uozumi
(Y)
Masahiko Tanaka
(M)
Shunsuke Shiraga
(S)
Shuji Sato
(S)
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(M)
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(K)
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(N)
Yasuhiro Fujimoto
(Y)
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(K)
Masaaki Iwase
(M)
Shinichi Yagi
(S)
Atsushi Tsuchiya
(A)
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(J)
Akira Watanabe
(A)
Sadao Kaneko
(S)
Naoto Kuwayama
(N)
Junya Hayashi
(J)
Masaaki Uno
(M)
Masayuki Sasou
(M)
Sotaro Higashi
(S)
Kazunari Yoshida
(K)
Masakazu Kitahara
(M)
Satoshi Suzuki
(S)
Sumio Suda
(S)
Amami Kato
(A)
Yusaku Nakamura
(Y)
Satoshi Magarisawa
(S)
Kenji Hashimoto
(K)
Hiroyuki Matsumoto
(H)
Hirotoshi Hamaguchi
(H)
Tomohiko Satou
(T)
Masaru Idei
(M)
Haruhisa Tsukamoto
(H)
Eiichiro Kamatsuka
(E)
Toshihiro Kumabe
(T)
Naoaki Sato
(N)
Yasuyuki Toba
(Y)
Nobuyuki Sakai
(N)
Takashi Tominaga
(T)
Haruo Yamashita
(H)
Eiji Kohmura
(E)
Masanori Morimoto
(M)
Tetsuya Ueba
(T)
Toyoaki Shinohara
(T)
Kazuyoshi Watanabe
(K)
Hidenori Endo
(H)
Kenjirou Hujiwara
(K)
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(K)
Toshinori Hasegawa
(T)
Hisashi Nitta
(H)
Kuroyanagi Takayuki
(K)
Nobuhiko Mizutani
(N)
Akira Tsunoda
(A)
Fumio Suzuki
(F)
Tetsuya Morimoto
(T)
Takuya Kawai
(T)
Mitsuyuki Fujitsuka
(M)
Akira Takada
(A)
Hiromasa Tsuiki
(H)
Junichi Kuratsu
(J)
Masaki Chin
(M)
Hidemichi Sasayama
(H)
Shigehiro Ohmori
(S)
Seiko Hasegawa
(S)
Kazuhiro Kikuchi
(K)
Motohiro Morioka
(M)
Masanori Isobe
(M)
Masanori Isobe
(M)
Masayuki Yokota
(M)
Nozomu Murai
(N)
Yasumasa Yamamoto
(Y)
Nobuhito Mori
(N)
Minoru Kidooka
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(H)
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(S)
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(Y)
Hitonori Takaba
(H)
Sei Haga
(S)
Koji Iihara
(K)
Yoshinori Arai
(Y)
Toshiyuki Tsukada
(T)
Hirohide Karasudani
(H)
Kenji Hashimoto
(K)
Masakazu Suga
(M)
Kawamoto Yukihiko
(K)
Hiroaki Fujiwara
(H)
Naoto Izumi
(N)
Youtarou Takeuchi
(Y)
Motohiro Arai
(M)
Hidenori Suzuki
(H)
Shinji Okumura
(S)
Hiromasa Tsuiki
(H)
Tomoyoshi Oikawa
(T)
Hisashi Tanaka
(H)
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(Y)
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(T)
Takashi Matsuoka
(T)
Masahiko Kasai
(M)
Hitoshi Miyake
(H)
Hajime Ohta
(H)
Osamu Hamasaki
(O)
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(M)
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(N)
Yosimasa Kinosita
(Y)
Hiroshi Ooyama
(H)
Hiroyuki Kaidu
(H)
Tarou Komuro
(T)
Hiroaki Shigeta
(H)
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Shigekazu Takeuchi
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Takayuki Matsuo
(T)
Yoshiharu Tokunaga
(Y)
Norimoto Nakahara
(N)
Nobukazu Hashimoto
(N)
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Junpei Yoshimoto
(J)
Toshihiko Wakabayashi
(T)
Jin Momoji
(J)
Kenji Kamiyama
(K)
Koji Oka
(K)
Hiromichi Koga
(H)
Kazuya Morimoto
(K)
Tsutomu Kadekaru
(T)
Hiroyuki Nakase
(H)
Junichi Iida
(J)
Michio Nakamura
(M)
Hiroharu Kataoka
(H)
Naoki Tokumitsu
(N)
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(Y)
Hirokazu Tanno
(H)
Hiroyuki Masaoka
(H)
Hiroshi Nakane
(H)
Takato Kagawa
(T)
Masaaki Saiki
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Satoshi Ushikoshi
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(K)
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(J)
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(K)
Akira Nakamizo
(A)
Yoshinari Nakamura
(Y)
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(EI)
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(N)
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(H)
Chiaki Takahashi
(C)
Youichirou Namba
(Y)
Kazuo Hashikawa
(K)
Tomonori Yamada
(T)
Masayuki Ezura
(M)
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(K)
Keiichi Sakai
(K)
Katsuhiro Kuroda
(K)
Hideyuki Kurihara
(H)
Masayuki Ishihara
(M)
Hideki Sakai
(H)
Masayuki Miyazono
(M)
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(K)
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(A)
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(H)
Akihiko Saito
(A)
Hiroyuki Arai
(H)
Igarashi Michitoku
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Shunichi Yoneda
(S)
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Hiroji Miyake
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Masahisa Kawakami
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Yu Takeda
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Ryoichi Hayashi
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Koji Tokunaga
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Tomoaki Nagamine
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(M)
Akira Isoshima
(A)
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Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: KI reports grant support from Idorsia Pharmaceuticals Japan Limited. The other authors report no conflicts of interest.
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