BMJ Open (Apr 2023)

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

  • Satoshi Suzuki,
  • Kenji Yamamoto,
  • Hiroaki Tanaka,
  • Hiroshi Ozawa,
  • Yuji Okamoto,
  • Tatsuya Abe,
  • Hidenori Suzuki,
  • Akiko Kada,
  • Shigeki Nishino,
  • Nobuyuki Sakai,
  • Kunihiro Nishimura,
  • Tomoyoshi Oikawa,
  • Takanari Kitazono,
  • Hiroshi Tanaka,
  • Daisuke Onozuka,
  • Akihito Hagihara,
  • Hiroshi Ooyama,
  • Akira Watanabe,
  • Shinichi Yoshimura,
  • Toru Iwama,
  • Hiroki Sato,
  • Satoshi Ushikoshi,
  • Kiyohiro Houkin,
  • Nobuhiro Mikuni,
  • Naoyuki Nakao,
  • Michio Nakamura,
  • Nanako Tamiya,
  • Naofumi Isono,
  • Koji Iihara,
  • Yutaka Yamaguchi,
  • Kuniaki Ogasawara,
  • Osamu Onodera,
  • Yusaku Nakamura,
  • Naoki Hayashi,
  • Akira Takada,
  • Masayuki Ezura,
  • Akio Hyodo,
  • Shigeru Miyachi,
  • Susumu Miyamoto,
  • Yuji Matsumaru,
  • Ichiro Nakahara,
  • Tomoaki Terada,
  • Kazunari Yoshida,
  • Ai Kurogi,
  • Ataru Nishimura,
  • Yoshiaki Shiokawa,
  • Koichi Arimura,
  • Kaoru Kurisu,
  • Fusao Ikawa,
  • Kenji Ohata,
  • Kyoichi Nomura,
  • Nobuhito Saito,
  • Hiroaki Fujiwara,
  • Susumu Suzuki,
  • Masanori Isobe,
  • Soshiro Ogata,
  • Takeshi Matsuoka,
  • Junichiro Satomi,
  • Takashi Matsumoto,
  • Hiroyuki Nakase,
  • Yasunari Niimi,
  • Manabu Kinoshita,
  • Mamoru Murakami,
  • Masaaki Uno,
  • Junichi Iida,
  • Takashi Matsuoka,
  • Tatsuya Sasaki,
  • Shinichi Wakabayashi,
  • Hiroki Toda,
  • Hideki Sakai,
  • Hajime Ohta,
  • Osamu Yamamura,
  • Hideyuki Ohnishi,
  • Hiroko Oyama,
  • Junichi Ono,
  • Izumi Nagata,
  • Hiroharu Kataoka,
  • Ryota Kurogi,
  • Hajime Arai,
  • Atsuo Yoshino,
  • Tsuyoshi Ohta,
  • Hiroshi Sugimori,
  • Hidehiro Hirabayashi,
  • Hiroyuki Masaoka,
  • Satoshi Yamamoto,
  • Hideki Murakami,
  • Kazuhiko Nozaki,
  • Hiroyuki Matsumoto,
  • Yuichiro Tanaka,
  • Takahisa Mori,
  • Keizo Yasui,
  • Akira Takahashi,
  • Ichiro Suzuki,
  • Sachio Suzuki,
  • TAKASHI YOSHIDA,
  • Masanori Morimoto,
  • Tetsuya Ueba,
  • Hiromu Hadeishi,
  • Masaki Chin,
  • Michihiro Kohno,
  • Hitoshi Fukuda,
  • Toru Nishi,
  • Kazunari Koga,
  • Toshihiko Wakabayashi,
  • Hiroki Ohkuma,
  • Kazuhiro Hongo,
  • Hiroshi Nakane,
  • Kazumi Nitta,
  • Satoshi Utsuki,
  • Toshihiko Iuchi,
  • Nice Ren,
  • Hidefuku Gi,
  • Kensuke Kawai,
  • Masayuki Ishihara,
  • Eiji Kohmura,
  • Yoshihiro Nishiura,
  • Kazutaka Yatsushiro,
  • Kensaku Yoshida,
  • Atsushi Tominaga,
  • Masayuki Sumida,
  • Hidenori Yoshida,
  • Atsushi Sato,
  • Takashi Inoue,
  • Hiroaki Shimizu,
  • Eiichiro Kamatsuka,
  • Makoto Ichinose,
  • Naoya Takeda,
  • Tsuyoshi Inoue,
  • Hidekazu Takahashi,
  • Satoshi Kuroda,
  • Toshiaki Osato,
  • Nobutaka Horie,
  • Isao Date,
  • Yoichiro Hashimoto,
  • Haruhiko Hoshino,
  • Takafumi Shimogawa,
  • Koji Yoshimoto,
  • Teiji Tominaga,
  • Isao Sasaki,
  • Kazuo Kitazawa,
  • Minoru Saitoh,
  • Hitoshi Saito,
  • Minoru Asahi,
  • Makoto Goda,
  • Atsuhito Takemura,
  • Masaaki Shibukawa,
  • Isao Fuwa,
  • Saburo Watanabe,
  • Seiko Kataoka,
  • Koji Takasaki,
  • Kouji Shiga,
  • Kensuke Hayashida,
  • Ryunosuke Uranishi,
  • Chiaki Ito,
  • Kenji Wakui,
  • Takashi Saegusa,
  • Isao Kitahara,
  • Yasushi Ejima,
  • Satoru Hayashi,
  • Kazuyoshi Hattori,
  • Shinji Okita,
  • Toshikazu Ichihashi,
  • Tsugumichi Ichioka,
  • Shinichi Shirakami,
  • Teruo Kimura,
  • Tomonori Kobayashi,
  • Kanehisa Kohno,
  • Kazunori Yamanaka,
  • Akira Morooka,
  • Nozomi Mori,
  • Hideo Kunimine,
  • Masahiro Satoh,
  • Syougo Imae,
  • Hirochiyo Wada,
  • Masanori Kabuto,
  • Katsuyuki Hirakawa,
  • Isao Inoue,
  • Kiyoshi Kazekawa,
  • Masani Nonaka,
  • Kouzou Fukuyama,
  • Shigenari Kin,
  • Kiyoshi Saito,
  • Yoichi Watanabe,
  • Tadashi Arisawa,
  • Kou Takahashi,
  • Tetsuya Tanigawara,
  • Junki Ito,
  • Kei Hisada,
  • Makoto Takeda,
  • Jun Niwa,
  • Mikio Nishiya,
  • Shuji Hayashi,
  • Ichiro Fujishima,
  • Teiji Nakayama,
  • Yoshihiko Watanabe,
  • Koichirou Matsukado,
  • Takamichi Yuguchi,
  • Tadahisa Shono,
  • Hiroyuki Nishimura,
  • Jyunya Hayashi,
  • Keisuke Migita,
  • Kazuhiro Yokoyama,
  • Hirotoshi Ohtaka,
  • Takata Hisashi,
  • Takamitsu Uchizawa,
  • Naoki Shinohara,
  • Mitsunobu Kaijima,
  • Junkoh Yamamoto,
  • Yoshio Sakagami,
  • Hideo Aihara,
  • Takayuki Sakaki,
  • Keishi Fujita,
  • Sumio Kobayashi,
  • Nobuaki Momozaki,
  • Masahito Hara,
  • Akazi Kazunori,
  • Fumitaka Miya,
  • Hisato Minamide,
  • Shinichiro Kurokawa,
  • Syuichi Ishikawa,
  • Naohisa Miura,
  • Shinya Noda,
  • Shoji Mashiyama,
  • Shinji Amano,
  • Takayuki Sugawara,
  • Yukihiko Shimizu,
  • Keiichi Saito,
  • Kazuyuki Miura,
  • Akinori Yabuta,
  • Tatumi Yamanome,
  • Hiroshi Seto,
  • Makoto Hasebe,
  • Hikaru Mizobuchi,
  • Junkoh Sasaki,
  • Shin Tsuruoka,
  • Keiichi Nishimaki,
  • Katsumi Takizawa,
  • Hitoshi Tsugu,
  • Nozomi Suzuki,
  • Takeshi Kohno,
  • Shu Hasegawa,
  • Ken Asakura,
  • Masaki Miyatake,
  • Hiromu Konno,
  • Katsunobu Takenaka,
  • Akira Ikeda,
  • Keizou Yamamoto,
  • Keigo Matsumoto,
  • Satoshi Inoha,
  • Masaki Morisige,
  • Kunihiko Harada,
  • Hirofumi Hiyama,
  • Yasuaki Takeda,
  • Taturou Mori,
  • Takekazu Akiyama,
  • Osamu Okuda,
  • Kazuaki Awamori,
  • Naoki Shirasaki,
  • Kimihiro Yoshino,
  • Atsushi Shindo,
  • Kazuho Hirahara,
  • Shunichi Tanaka,
  • Teruaki Kawano,
  • Kazunori Arita,
  • Hiroaki Sawaura,
  • Yoichi Uozumi,
  • Masahiko Tanaka,
  • Shunsuke Shiraga,
  • Shuji Sato,
  • Mitsutoshi Nakada,
  • Kimihisa Kinoshita,
  • Nakazawa Kazutomo,
  • Yasuhiro Fujimoto,
  • Kunikazu Yoshimura,
  • Masaaki Iwase,
  • Shinichi Yagi,
  • Atsushi Tsuchiya,
  • Junichi Harashina,
  • Sadao Kaneko,
  • Naoto Kuwayama,
  • Junya Hayashi,
  • Masayuki Sasou,
  • Sotaro Higashi,
  • Masakazu Kitahara,
  • Sumio Suda,
  • Amami Kato,
  • Satoshi Magarisawa,
  • Kenji Hashimoto,
  • Hirotoshi Hamaguchi,
  • Tomohiko Satou,
  • Masaru Idei,
  • Haruhisa Tsukamoto,
  • Toshihiro Kumabe,
  • Naoaki Sato,
  • Yasuyuki Toba,
  • Takashi Tominaga,
  • Haruo Yamashita,
  • Toyoaki Shinohara,
  • Kazuyoshi Watanabe,
  • Hidenori Endo,
  • Kenjirou Hujiwara,
  • Toshinori Hasegawa,
  • Hisashi Nitta,
  • Kuroyanagi Takayuki,
  • Nobuhiko Mizutani,
  • Akira Tsunoda,
  • Fumio Suzuki,
  • Tetsuya Morimoto,
  • Takuya Kawai,
  • Mitsuyuki Fujitsuka,
  • Hiromasa Tsuiki,
  • Junichi Kuratsu,
  • Hidemichi Sasayama,
  • Shigehiro Ohmori,
  • Seiko Hasegawa,
  • Kazuhiro Kikuchi,
  • Motohiro Morioka,
  • Masayuki Yokota,
  • Nozomu Murai,
  • Yasumasa Yamamoto,
  • Nobuhito Mori,
  • Minoru Kidooka,
  • Hiroshi Tenjin,
  • Yoshihiro Iwamoto,
  • Hitonori Takaba,
  • Sei Haga,
  • Yoshinori Arai,
  • Toshiyuki Tsukada,
  • Hirohide Karasudani,
  • Masakazu Suga,
  • Kawamoto Yukihiko,
  • Naoto Izumi,
  • Youtarou Takeuchi,
  • Motohiro Arai,
  • Shinji Okumura,
  • Hisashi Tanaka,
  • Yasushi Shibata,
  • Tetsuya Masaoka,
  • Masahiko Kasai,
  • Hitoshi Miyake,
  • Osamu Hamasaki,
  • Misao Nishikawa,
  • Naohiko Kubo,
  • Yosimasa Kinosita,
  • Hiroyuki Kaidu,
  • Tarou Komuro,
  • Hiroaki Shigeta,
  • Yoshikazu Kusano,
  • Shigekazu Takeuchi,
  • Takayuki Matsuo,
  • Yoshiharu Tokunaga,
  • Norimoto Nakahara,
  • Nobukazu Hashimoto,
  • Mitsuhito Mase,
  • Junpei Yoshimoto,
  • Jin Momoji,
  • Kenji Kamiyama,
  • Koji Oka,
  • Hiromichi Koga,
  • Kazuya Morimoto,
  • Tsutomu Kadekaru,
  • Naoki Tokumitsu,
  • Yasuyuki Nagai,
  • Hirokazu Tanno,
  • Takato Kagawa,
  • Masaaki Saiki,
  • Kotaro Ogihara,
  • Junichi Imamura,
  • Katsuhiro Yamashita,
  • Akira Nakamizo,
  • Yoshinari Nakamura,
  • Ei-Ichirou Urasaki,
  • Noriyuki Suzaki,
  • Chiaki Takahashi,
  • Youichirou Namba,
  • Kazuo Hashikawa,
  • Tomonori Yamada,
  • Kazuyuki Kuwayama,
  • Keiichi Sakai,
  • Katsuhiro Kuroda,
  • Hideyuki Kurihara,
  • Masayuki Miyazono,
  • Kosuke Miyahara,
  • Hideaki Takahashi,
  • Akihiko Saito,
  • Igarashi Michitoku,
  • Mitsuo Kouno,
  • Shiro Kobayashi,
  • Shunichi Yoneda,
  • Hiroshi Kusunoki,
  • Hiroji Miyake,
  • Toshio Yokoe,
  • Tatsuya Nakamura,
  • Takayuki Kubodera,
  • Mitsuhiko Hokari,
  • Yasunari Otawara,
  • Cheho Park,
  • Hidemitu Nakagawa,
  • Souichi Obara,
  • Haruki Takahashi,
  • Masafumi Ohtaki,
  • Atsuya Okubo,
  • Katsuhiko Hayashi,
  • Masahisa Kawakami,
  • Yu Takeda,
  • Akihiko Kaga,
  • Ryoichi Hayashi,
  • Koji Tokunaga,
  • Hiroyuki Nakashima,
  • Yasuyuki Miyoshi,
  • Atusi Kimoto,
  • Toshimitsu Uchihara,
  • Tomoaki Nagamine,
  • Masahiro Noha,
  • Hiromichi Sadashima,
  • Toshihiko Kinjo,
  • Osamu Tao,
  • Masayuki Nakajima,
  • Akira Isoshima,
  • Kouichi Kuramoto,
  • Shigeru Daido,
  • Yoshiyasu Iwai,
  • Toshihiko Kuroiwa,
  • Akatsuki Wakayama,
  • Kohsuke Yamashita,
  • Yasunobu Gotou,
  • Kouich Iwatsuki,
  • Yoshida Masahiro,
  • Nobuaki Kobayasi,
  • Yoshimasa Niiya,
  • Syouji Mabuchi,
  • Motohiro Takayama,
  • Kazuo Yamamoto,
  • Junta Moroi,
  • Masato Sugitani,
  • Akio Ookura,
  • Naoko Fujimura,
  • Osamu Nishizaki,
  • Sumio Isimaru,
  • Hiroshi Wanihuchi,
  • Nobukuni Murakami,
  • Hiroto Murata,
  • Naoki Kitagawa,
  • Katsuhiko Kono,
  • Michiya Kubo,
  • Masashi Nakatsukasa,
  • Makoto Inaba,
  • Hidetoshi Ooigawa,
  • Atsuhiro Kojima,
  • Takamitsu Fujimaki,
  • Osamu Fukuda,
  • Yoshikazu Nakajima,
  • Kazuyuki Kouno,
  • Takaaki Yoshida,
  • Reizou Kanemaru,
  • Yohei Kudoh,
  • Toshitaka Nakamura,
  • Masayoshi Takigami,
  • Shogo Nishi,
  • Rokuya Tanikawa,
  • Seisaburo Sakamoto,
  • Makio Kaminogo,
  • Seiichiro Hoshi,
  • Yoshinari Okumura,
  • Shinichi Okabe,
  • Haruhiko Sato,
  • Shiro Miyata,
  • Kotaro Tsumura,
  • Hiroshi Karibe,
  • Noriaki Watabe,
  • Ryuji Nakamura,
  • Norifumi Shimoeda,
  • Tsutomu Hitotsumatsu,
  • Tomoaki Kameda,
  • Hiroshi Ishiguchi,
  • Atsuo Shinoda,
  • Masanobu Hokama,
  • Akinori Yamamura,
  • Takeshi Kondoh,
  • Kenichi Murao,
  • Takafumi Wataya,
  • Seiji Fukazawa,
  • Shinsuke Muraoka,
  • Hirosuke Fujisawa,
  • Tsuneo Shishido,
  • Mayumi Mori,
  • Arai Hiroaki,
  • Shinjitsu Nishimura,
  • Zenichiro Watanabe,
  • Susumu Nakashima,
  • Kazuhito Nakamura,
  • Yukinari Kakizawa,
  • Hiroki Takano,
  • Norihito Shirakawa,
  • Masahiro Kagawa,
  • Eiichiro Mabuchi,
  • Kazusige Maeno,
  • Takayuki Koizumi,
  • Warou Taki,
  • Yusuke Nakagaki,
  • Kazuyuki Tane,
  • Hiromichi Ooishi,
  • Katsuyuki Asaoka,
  • Yoshinori Akiyama,
  • Tadao Kawamura,
  • Atumi Takenobu,
  • Takehisa Tuji,
  • Masami Shimoda,
  • Mitsunori Matsumae,
  • Shinji Noda,
  • Koiti Moroki,
  • Hirofumi Oka,
  • Masahito Agawa,
  • Hajimu Miyake,
  • Masateru Katayama,
  • Shinichi Numazawa,
  • Taketoshi Maehara,
  • Hiroyuki Jimbo,
  • Satoshi Ihara,
  • Koji Matuoka,
  • Oikawa Akihiro,
  • Takahiro Oota,
  • Makoto Noguchi,
  • Takakazu Kawamata,
  • Youichi Hashimoto,
  • Keiichirou Onitsuka,
  • Masahiko Kitano,
  • Jae-Hyun Son,
  • Toru Masuoka,
  • Naoki Koketsu,
  • Keiichi Akatsuka,
  • Masamichi Kurosaki,
  • Miyamori Tadao,
  • Hiroaki Hondo,
  • Kazumasa Yamatani,
  • Hirofumi Oyama,
  • Junji Koyama,
  • Ogura Koichiro,
  • Shinji Yamamoto,
  • Hitoshi Tabata,
  • Kazuya Uemura,
  • Kazuhiko Sato,
  • Hideyuki Yoshida,
  • Takafumi Nishizaki,
  • Hiroshi Egami,
  • Hideo Takeshima,
  • Shogo Ishiuchi,
  • Akira Matsumura,
  • Hiroyuki Kinouchi,
  • Susumu Mekaru,
  • Mikihiko Takeshita,
  • Hitoshi Ozawa,
  • Kiichiro Zenke,
  • Takeshi Matsuyama,
  • Toshikazu Kuwata,
  • Teruyuki Habu,
  • Tomoyoshi Okumura,
  • Seiya Takehara,
  • Rei Kondo,
  • Takashi Kumagai,
  • Keiten So,
  • Sunao Takemura,
  • Sonoda Yukihiko,
  • Manabu Urakawa,
  • Yasuhiro Hamada,
  • Michiyasu Suzuki,
  • Mikito Uchida,
  • Hidehito Koizumi,
  • Masaru Yamada,
  • Takashi Tsuruno,
  • Gen Ishida,
  • Ryouichi Masuda,
  • Makoto Kimura,
  • Shinichirou Ishihara,
  • Masashi Morikawa,
  • Hidetoshi Murata,
  • Katsumi Sakata,
  • Motohiro Nomura,
  • Akihiro Nemoto,
  • Sumio Endou,
  • Nobuo Hirota,
  • Kennji Itou,
  • Hiroaki Minami,
  • Yoshihumi Teramoto

DOI
https://doi.org/10.1136/bmjopen-2022-068642
Journal volume & issue
Vol. 13, no. 4

Abstract

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Objectives 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.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures 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).Results 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.Conclusions 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.