Patient volume and quality of care for the treatment of stroke or intracranial aneurysm
Report
|Updated
Update of our previous systematic review on patient volume and quality of care to assess new publications on the treatment of stroke or intracranial aneurysm.
Key message
The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new publications on the treatment of stroke or intracranial aneurysm. This work was undertaken as a rapid review.
We searched for publications in Medline for the period January 2006 to August 2008 that extends our previous search to cover the period back to 1990. We included studies that assessed hospital or surgeon volume and outcomes for patients treated for stroke or intracranial aneurysm.
One new study for the treatment of stroke was included, that together with the previously assessed studies adds to six publications. Three publications were from a German quality register, two studies analyzed administrative data from the U.S. and one study administrative data from Canada.
Altogether the literature on the importance of hospital volume of stroke treatment is limited, and the results were not unique.
- Analyses from a German quality register concluded that hospital volume was associated with improved outcome for thrombolytic treatment, but not for other interventions.
- Analysis from the United States concluded that hospital volume was significant for the treatment of stroke patients in general, but not for thrombolysis patients.
- The Canadian study found higher rates of mortality for patients with ischemic stroke in low volume hospitals.
- The definition of low volume hospitals ranged from under 19 to 50 annual procedures year, while the definition of high-volume hospitals ranged from over 125 to over 300 stroke patients per year. For thrombolysis patients only, low hospital volume was defined as less than 5 patients per year, while high volume was defined as over 5 to 15 patients per year.
We did not find any new studies for intracranial aneurysm.