Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference?
Background: Publicly reported hospital risk-adjusted mortality rates (RAMRs) reflect real-world outcomes and may be used to understand the impact of advances in medical evidence. Our study presents an analysis of RAMRs in California hospitals across the time period of publication of major trials in...
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Elsevier
2025-04-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139725000109 |
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| author | Suraj Shah Aymen Kabir Rithvik Ramesh Youssef Sibih Alexander F. Haddad Daniel S. Raper |
| author_facet | Suraj Shah Aymen Kabir Rithvik Ramesh Youssef Sibih Alexander F. Haddad Daniel S. Raper |
| author_sort | Suraj Shah |
| collection | DOAJ |
| description | Background: Publicly reported hospital risk-adjusted mortality rates (RAMRs) reflect real-world outcomes and may be used to understand the impact of advances in medical evidence. Our study presents an analysis of RAMRs in California hospitals across the time period of publication of major trials in stroke intervention, to interrogate the effect of these trials upon population-level mortality from stroke. Methods: Stroke (total acute, ischemic, hemorrhagic, subarachnoid hemorrhage) RAMR data from 2010 to 2020 was extracted from the California Hospital Inpatient Mortality Rates and Quality Ratings dataset. Hospitals were categorized by county population, size and type (academic/community). ANOVA with Tukey–Kramer and Bonferroni-corrected t-tests, and independent t-tests were used for statistical comparison of RAMRs across different population groups and hospital types. Results: There was a statewide decline in acute stroke mortality from 11.4 % to 8.6 %, with ischemic stroke mortality decreasing from 24.9 % to 21.6 %. RAMRs decreased from 5.7 % to 5.0 % in community hospitals (p = 0.006), a trend not mirrored in academic settings. Hemorrhagic stroke RAMRs fluctuated, while subarachnoid hemorrhage RAMRs increased, except in academic institutions. Hospitals in the >2M population group had significantly lower RAMRs (p < 0.005) than the 0-500k group. There were no significant RAMR differences between academic and community hospitals across all stroke types. Conclusions: Despite the publication of paradigm-shifting trials, California in-patient stroke mortality only modestly changed, reflecting the complexity of replicating clinical trial outcomes in real-world data. Consistent, longitudinal quality and outcome metrics at state and national levels remain essential for understanding the impact of clinical research and innovation. |
| format | Article |
| id | doaj-art-284a60abac674fa7965dc905fa7ad3eb |
| institution | OA Journals |
| issn | 2590-1397 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | World Neurosurgery: X |
| spelling | doaj-art-284a60abac674fa7965dc905fa7ad3eb2025-08-20T02:19:48ZengElsevierWorld Neurosurgery: X2590-13972025-04-012610043610.1016/j.wnsx.2025.100436Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference?Suraj Shah0Aymen Kabir1Rithvik Ramesh2Youssef Sibih3Alexander F. Haddad4Daniel S. Raper5University of California, Berkeley, Berkeley, CA, USAUniversity of California, San Francisco School of Medicine, San Francisco, CA, USAUniversity of California, San Francisco School of Medicine, San Francisco, CA, USAUniversity of California, San Francisco School of Medicine, San Francisco, CA, USADepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USADepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Corresponding author. Dept. of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M-779, San Francisco, CA, 94143-0112, USA.Background: Publicly reported hospital risk-adjusted mortality rates (RAMRs) reflect real-world outcomes and may be used to understand the impact of advances in medical evidence. Our study presents an analysis of RAMRs in California hospitals across the time period of publication of major trials in stroke intervention, to interrogate the effect of these trials upon population-level mortality from stroke. Methods: Stroke (total acute, ischemic, hemorrhagic, subarachnoid hemorrhage) RAMR data from 2010 to 2020 was extracted from the California Hospital Inpatient Mortality Rates and Quality Ratings dataset. Hospitals were categorized by county population, size and type (academic/community). ANOVA with Tukey–Kramer and Bonferroni-corrected t-tests, and independent t-tests were used for statistical comparison of RAMRs across different population groups and hospital types. Results: There was a statewide decline in acute stroke mortality from 11.4 % to 8.6 %, with ischemic stroke mortality decreasing from 24.9 % to 21.6 %. RAMRs decreased from 5.7 % to 5.0 % in community hospitals (p = 0.006), a trend not mirrored in academic settings. Hemorrhagic stroke RAMRs fluctuated, while subarachnoid hemorrhage RAMRs increased, except in academic institutions. Hospitals in the >2M population group had significantly lower RAMRs (p < 0.005) than the 0-500k group. There were no significant RAMR differences between academic and community hospitals across all stroke types. Conclusions: Despite the publication of paradigm-shifting trials, California in-patient stroke mortality only modestly changed, reflecting the complexity of replicating clinical trial outcomes in real-world data. Consistent, longitudinal quality and outcome metrics at state and national levels remain essential for understanding the impact of clinical research and innovation.http://www.sciencedirect.com/science/article/pii/S2590139725000109Academic hospitalCommunity hospitalEndovascular thrombectomyHemorrhagic strokeIschemic strokeRisk-adjusted mortality rate |
| spellingShingle | Suraj Shah Aymen Kabir Rithvik Ramesh Youssef Sibih Alexander F. Haddad Daniel S. Raper Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? World Neurosurgery: X Academic hospital Community hospital Endovascular thrombectomy Hemorrhagic stroke Ischemic stroke Risk-adjusted mortality rate |
| title | Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? |
| title_full | Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? |
| title_fullStr | Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? |
| title_full_unstemmed | Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? |
| title_short | Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference? |
| title_sort | trends in stroke related mortality in california hospitals from 2010 to 2020 have the large core stroke trials made a difference |
| topic | Academic hospital Community hospital Endovascular thrombectomy Hemorrhagic stroke Ischemic stroke Risk-adjusted mortality rate |
| url | http://www.sciencedirect.com/science/article/pii/S2590139725000109 |
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