Abstract:
:The present study conducted risk-adjusted analyses to investigate the impacts of hospital and surgeon volumes on postoperative complications and the modified Rankin scale (mRS) after intracranial clipping of unruptured aneurysms, and to discuss the efficacy of relevant policy changes. Among 107 Japanese institutions, physician-reported data for 702 unruptured aneurysm patients were registered between December 2006 and April 2007. Postoperative complications and the mRS at the time of discharge were independently regressed against hospital and surgeon volumes, aneurysm size, aneurysm location, and comorbidities. Aneurysm size was a significant predictor of the overall outcomes. After adjusting for prominent confounders, hospital volume did not show any significant associations with postoperative complications (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.34-1.68, p = 0.49) or the mRS (OR 0.60, 95% CI 0.19-1.93, p = 0.39). Higher surgeon volume (>or=100) was associated with lower mRS scores (OR 0.40, 95% CI 0.20-0.83, p = 0.013), but had no significant relationship with postoperative complications (OR 0.72, p = 0.47). Our risk-adjusted analyses showed no significant relationships between hospital volume and comorbidities. Therefore, the justification for hospital volume-based policies remains unclear. Prospective risk-adjusted volume-based studies are required for future evidence-based referral policies.
journal_name
Neurol Med Chir (Tokyo)journal_title
Neurologia medico-chirurgicaauthors
Yasunaga H,Matsuyama Y,Ohe K,Japan Neurosurgical Society.doi
10.2176/nmc.48.531subject
Has Abstractpub_date
2008-12-01 00:00:00pages
531-8; discussion 538issue
12eissn
0470-8105issn
1349-8029pii
JST.JSTAGE/nmc/48.531journal_volume
48pub_type
杂志文章abstract::C-stopper coil (CSC) which are available for 0.018-inch inner diameter microcenter have been used for neurointervention such as transarterial embolization (TAE) of feeding artery. Although various shapes of pushable microcoils have been developed, microcoils are usually short to embolize the lesion and require lots of...
journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.oa.2013-0154
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abstract::A 51-year-old woman presented with a rare variation in the location of the anterior communicating artery (AComA) complex associated with aneurysm manifesting as sudden onset of headache. Computed tomography (CT) revealed widespread subarachnoid hemorrhage with intracerebral hematoma and intraventricular hemorrhage. Th...
journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.48.254
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abstract::Modern imaging technologies, such as computed tomography (CT) angiography, magnetic resonance (MR) angiography, and digital subtraction (DS) angiography are widely used for pretreatment evaluation of cerebral aneurysms, but the relative accuracies of these modalities are unclear. This study compared the measurements o...
journal_title:Neurologia medico-chirurgica
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doi:10.2176/nmc.50.893
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abstract::We describe the efficacy and technical aspects of infiltrated preoperative embolization of meningioma by penetration of very dilute glue. In this method, a 13% n-butyl-cyanoacrylate (NBCA)-lipiodol mixture is injected extremely slowly from the middle meningeal artery (MMA) in a similar manner to plug and push injectio...
journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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doi:10.2176/nmc.38.503
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journal_title:Neurologia medico-chirurgica
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abstract::A case of spinal cord glioblastoma multiforme with intracranial dissemination is reported. A 23-year-old female was admitted to a local hospital complaining of lumbago. Myelography revealed an intramedullary thoracic tumor. The tumor was partially removed through a laminectomy at Th11-L1. The histological diagnosis wa...
journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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doi:10.2176/nmc.38.suppl_161
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.tn.2014-0040
更新日期:2014-01-01 00:00:00
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.47.222
更新日期:2007-05-01 00:00:00
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章,评审
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:
更新日期:2014-01-01 00:00:00
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.45.480
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
pub_type: 杂志文章
doi:10.2176/nmc.tn.2018-0149
更新日期:2018-11-15 00:00:00
abstract::A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved follo...
journal_title:Neurologia medico-chirurgica
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journal_title:Neurologia medico-chirurgica
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更新日期:2010-01-01 00:00:00
abstract::A curved ventricular catheter was designed for ventriculoperitoneal shunt procedures. The tip of the catheter can be inserted into the anterior horn along the curvature of the lateral ventricle. To date, it has been applied in 14 cases, all with satisfactory results. ...
journal_title:Neurologia medico-chirurgica
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更新日期:2013-01-01 00:00:00