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Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Cian J. O'Kelly ,
Julian Spears ,
David Urbach  and
M. Christopher Wallace
Cian J. O'Kelly*
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta
Julian Spears
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
David Urbach
Affiliation:
Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
M. Christopher Wallace
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurosurgery, Department of Neurosurgery, University of Alberta, 2D2.02 Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
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Abstract:

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Background:

In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.

Methods:

Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.

Results:

The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.

Conclusions:

Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

Résumé:

Résumé:Contexte:

Dans le traitement de l'hémorragie sous-arachnoïdienne (HSA), les complications précoces et la centralisation de ressources limitées constituent souvent un défi quand il s'agit de procurer des soins neurochirurgicaux en temps opportun. Nous avons évalué l'impact de la proximité du centre de soins neurochirurgicaux sur l'issue clinique après une HSA anévrismale.

Méthodes:

Nous avons analysé les données administratives de patients qui ont été traités pour une HSA anévrismale dans des centres de neurochirurgie en Ontario entre 1995 et 2004. Nous avons comparé la mortalité des patients qui ont reçu un traitement dans un centre de leur comté de résidence par rapport à ceux qui ont été traités en dehors de leur comté. Nous avons également examiné l'impact de la distance entre la résidence du patient et le centre de traitement.

Résultats:

Les taux de mortalité étaient significativement plus bas chez les patients qui avaient été traités dans leur comté par rapport à ceux qui avaient été traités en dehors de leur comté (23,5% vs 27,6%; p = 0,009). Cet avantage est demeuré significatif après ajustement pour les variantes confondantes potentielles (RR = 0,84; p = 0,01). La relation entre la distance du centre de traitement et la mortalité était biphasique. À moins de 300 km, la mortalité augmentait avec l'augmentation de la distance. Au-delà de 300 km, nous avons observé un bénéfice sur la survie.

Conclusions:

La proximité du centre de traitement neurochirurgical a un impact sur la survie après une HSA anévrismale. Ces résultats ont des implications significatives pour le triage de ces patients en état critique.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 36 - 40
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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