Impact of Hospital Caseload and Elective Admission on Outcomes After Extracranial-Intracranial Bypass Surgery

Hesam Akbarian-Tefaghi, Piyush Kalakoti, Hai Sun, Kanika Sharma, Jai Deep Thakur, Devi Prasad Patra, Rimal H. Dossani, Amey Savardekar, Christina Notarianni, Gregory J. Zipfel, Anil Nanda

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background Limited information exists evaluating the impact of hospital caseload and elective admission on outcomes after patients have undergone extracranial-intracranial (ECIC) bypass surgery. Using the Nationwide Inpatient Sample (NIS) for 2001–2014, we evaluated the impact of hospital caseload and elective admission on outcomes after bypass. Methods In an observational cohort study, weighted estimates were used to investigate the association of hospital caseload and elective admission on short-term outcomes after bypass surgery using multivariable regression techniques. Results Overall, 10,679 patients (mean age, 43.39 ± 19.63 years; 59% female) underwent bypass across 495 nonfederal U.S. hospitals. In multivariable models, patients undergoing bypass at high-volume centers were associated with decreased probability of mortality (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.22–0.70; P < 0.001), length of stay (OR, 0.86; 95% CI, 0.82–0.90; P < 0.001), postbypass neurologic complications (OR, 0.66; 95% CI, 0.49–0.89; P = 0.007), venous thromboembolism (OR, 0.69; 95% CI, 0.49–0.97; P = 0.033), and acute renal failure (OR, 0.45; 95% CI, 0.26–0.80; P = 0.007), and higher hospitalization cost (26.3% higher) compared with low-volume centers. Likewise, patients undergoing elective bypass were associated with decreased likelihood of mortality (OR, 0.38; 95% CI, 0.25–0.59; P < 0.001), unfavorable discharge (OR, 0.57; 95% CI, 0.43–0.76; P < 0.001), length of stay (OR, 0.62; 95% CI, 0.59–0.64; P < 0.001), venous thromboembolism (OR, 0.61; 95% CI, 0.49–0.77; P < 0.001), acute renal failure (OR, 0.64; 95% CI, 0.43–0.94; P = 0.022), wound complications (OR, 0.71; 95% CI, 0.53–0.96; P = 0.028), and lower hospitalization cost (34.5% lower) compared with nonelective admissions. Conclusions Our findings serve as a framework for strengthening referral networks for complex cases to centers performing high volumes of cerebral bypass. Also, our study supports improved outcomes in select patients undergoing elective bypass procedures.

Original languageEnglish
Pages (from-to)716-728
Number of pages13
JournalWorld neurosurgery
Volume108
DOIs
StatePublished - Dec 2017

Keywords

  • Aneurysm
  • Elective admission
  • Extracranial-intracranial bypass
  • Hospital caseload
  • Moyamoya disease
  • NIS

Fingerprint Dive into the research topics of 'Impact of Hospital Caseload and Elective Admission on Outcomes After Extracranial-Intracranial Bypass Surgery'. Together they form a unique fingerprint.

Cite this