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16-09-2022 | Subarachnoid Hemorrhage | Original work

Predictors of In-Hospital Mortality and Home Discharge in Patients with Aneurysmal Subarachnoid Hemorrhage: A 4-Year Retrospective Analysis

Authors: Uma V. Mahajan, Hammad A. Khan, Xiaofei Zhou, Shaarada Srivatsa, Christina H. Wright, Adam H. Bates, Martha Sajatovic, Nicholas C. Bambakidis

Published in: Neurocritical Care | Issue 1/2023

Abstract

Background

Factors associated with discharge disposition and mortality following aneurysmal subarachnoid hemorrhage (aSAH) are not well-characterized. We used a national all-payer database to identify factors associated with home discharge and in-hospital mortality.

Methods

The National Inpatient Sample was queried for patients with aSAH within a 4-year range. Weighted multivariable logistic regression models were constructed and adjusted for age, sex, race, household income, insurance status, comorbidity burden, National Inpatient Sample SAH Severity Score, disease severity, treatment modality, in-hospital complications, and hospital characteristics (size, teaching status, and region).

Results

Our sample included 37,965 patients: 33,605 were discharged alive and 14,350 were discharged home. Black patients had lower odds of in-hospital mortality compared with White patients (adjusted odds ratio [aOR] = 0.67, 95% confidence interval [CI] 0.52–0.86, p = 0.002). Compared with patients with private insurance, those with Medicare were less likely to have a home discharge (aOR = 0.58, 95% CI 0.46–0.74, p < 0.001), whereas those with self-pay (aOR = 2.97, 95% CI 2.29–3.86, p < 0.001) and no charge (aOR = 3.21, 95% CI 1.57–6.55, p = 0.001) were more likely to have a home discharge. Household income percentile was not associated with discharge disposition or in-hospital mortality. Paradoxically, increased number of Elixhauser comorbidities was associated with significantly lower odds of in-hospital mortality.

Conclusions

We demonstrate independent associations with hospital characteristics, patient characteristics, and treatment characteristics as related to discharge disposition and in-hospital mortality following aSAH, adjusted for disease severity.

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Jaja BNR, Saposnik G, Nisenbaum R, et al. Racial/ethnic differences in inpatient mortality and use of institutional postacute care following subarachnoid hemorrhage. J Neurosurg. 2013;119:1627–32. https://doi.org/10.3171/2013.7.JNS13544.CrossRefPubMed

Ovbiagele B. Nationwide trends in in-hospital mortality among patients with stroke. Stroke. 2010;41:1748–54. https://doi.org/10.1161/STROKEAHA.110.585455.CrossRefPubMed

Lagares A, Gómez PA, Alen JF, et al. A comparison of different grading scales for predicting outcome after subarachnoid haemorrhage. Acta Neurochir (Wien). 2005;147:5–16. https://doi.org/10.1007/s00701-004-0417-y.CrossRefPubMed

Hammer A, Ranaie G, Erbguth F, et al. Impact of complications and comorbidities on the intensive care length of stay after aneurysmal subarachnoid haemorrhage. Sci Rep. 2020;10:6228. https://doi.org/10.1038/s41598-020-63298-9.CrossRefPubMedPubMedCentral

Khatri R, Tariq N, Vazquez G, Suri MFK, Ezzeddine MA, Qureshi AI. Outcomes after nontraumatic subarachnoid hemorrhage at hospitals offering angioplasty for cerebral vasospasm: a national level analysis in the United States. Neurocrit Care. 2011;15:34–41. https://doi.org/10.1007/s12028-010-9423-5.CrossRefPubMed

Bateman BT, Olbrecht VA, Berman MF, Minehart RD, Schwamm LH, Leffert LR. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology. 2012;116:324–33. https://doi.org/10.1097/ALN.0b013e3182410b22.CrossRefPubMed

Brinjikji W, Lanzino G, Rabinstein AA, Kallmes DF, Cloft HJ. Age-related trends in the treatment and outcomes of ruptured cerebral aneurysms: a study of the nationwide inpatient sample 2001–2009. AJNR Am J Neuroradiol. 2013;34:1022–7. https://doi.org/10.3174/ajnr.A3321.CrossRefPubMedPubMedCentral

Hoh BL, Chi Y-Y, Waters MF, Mocco J, Barker FG. Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke. 2010;41:2323–8. https://doi.org/10.1161/STROKEAHA.110.591081.CrossRefPubMed

Washington CW, Derdeyn CP, Dacey RG, Dhar R, Zipfel GJ. Analysis of subarachnoid hemorrhage using the Nationwide Inpatient Sample: the NIS-SAH Severity Score and Outcome Measure. J Neurosurg. 2014;121:482–9. https://doi.org/10.3171/2014.4.JNS131100.CrossRefPubMed

10.

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27. https://doi.org/10.1097/00005650-199801000-00004.CrossRefPubMed

11.

Young B, Moyer M, Pino W, Kung D, Zager E, Kumar MA. Safety and feasibility of early mobilization in patients with subarachnoid hemorrhage and external ventricular drain. Neurocrit Care. 2019;31:88–96. https://doi.org/10.1007/s12028-019-00670-2.CrossRefPubMed

12.

Samuels O, Webb A, Culler S, Martin K, Barrow D. Impact of a dedicated neurocritical care team in treating patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;14:334–40. https://doi.org/10.1007/s12028-011-9505-z.CrossRefPubMed

13.

Pandey AS, Gemmete JJ, Wilson TJ, et al. High subarachnoid hemorrhage patient volume associated with lower mortality and better outcomes. Neurosurgery. 2015;77:462–70. https://doi.org/10.1227/NEU.0000000000000850.CrossRefPubMed

14.

Prabhakaran S, Fonarow GC, Smith EE, et al. Hospital case volume is associated with mortality in patients hospitalized with subarachnoid hemorrhage. Neurosurgery. 2014;75:500–8. https://doi.org/10.1227/NEU.0000000000000475.CrossRefPubMed

15.

Strickland BA, Mert M, Ravina K, et al. Discrepancy in neurologic outcomes following aneurysmal subarachnoid hemorrhage as a function of socioeconomic class. World Neurosurg. 2020;138:e787–94. https://doi.org/10.1016/j.wneu.2020.03.087.CrossRefPubMed

16.

Akintoye E, Briasoulis A, Egbe A, et al. Regional variation in mortality, length of stay, cost, and discharge disposition among patients admitted for heart failure in the United States. Am J Cardiol. 2017;120:817–24. https://doi.org/10.1016/j.amjcard.2017.05.058.CrossRefPubMed

17.

Larrew T, Pryor W, Weinberg J, et al. Aneurysmal subarachnoid hemorrhage: a statewide assessment of outcome based on risk factors, aneurysm characteristics, and geo-demography. J Neurointerv Surg. 2015;7:855–60. https://doi.org/10.1136/neurintsurg-2014-011359.CrossRefPubMed

18.

McIntyre MK, Gandhi C, Long A, et al. Age predicts outcomes better than frailty following aneurysmal subarachnoid hemorrhage: a retrospective cohort analysis. Clin Neurol Neurosurg. 2019;187:105558. https://doi.org/10.1016/j.clineuro.2019.105558.CrossRefPubMed

19.

Ross N, Hutchinson PJ, Seeley H, Kirkpatrick PJ. Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. J Neurol Neurosurg Psychiatry. 2002;72:480–4. https://doi.org/10.1136/jnnp.72.4.480.CrossRefPubMedPubMedCentral

20.

Awe OO, Gonzalez LF, Hasan D, Maltenfort M, Rossenwasser R, Jabbour P. Treatment outcome of aneurysmal subarachnoid hemorrhage in patients aged 70 years and older. Neurosurgery. 2011;68(3):753–8. https://doi.org/10.1227/NEU.0b013e318207a9fb.CrossRefPubMed

21.

Zacharia BE, Grobelny BT, Komotar RJ, Sander Connolly E, Mocco J. The influence of race on outcome following subarachnoid hemorrhage. J Clin Neurosci. 2010;17:34–7. https://doi.org/10.1016/j.jocn.2009.05.015.CrossRefPubMed

22.

Williamson T, Ryser MD, Ubel PA, et al. Withdrawal of life-supporting treatment in severe traumatic brain injury. JAMA Surg. 2020;155(8):723–31. https://doi.org/10.1001/jamasurg.2020.1790.CrossRefPubMedPubMedCentral

23.

James ML, Grau-Sepulveda MV, Olson DM, et al. Insurance status and outcome after intracerebral hemorrhage: findings from Get With The Guidelines-stroke. J Stroke Cerebrovasc Dis. 2014;23:283–92. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.016.CrossRefPubMed

24.

Lai PMR, Dasenbrock H, Lin N, Du R. The impact of insurance status on the outcomes after aneurysmal subarachnoid hemorrhage. PLoS ONE. 2013;8:e78047. https://doi.org/10.1371/journal.pone.0078047.CrossRefPubMedPubMedCentral

25.

Thompson NR, Fan Y, Dalton JE, et al. A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality. Med Care. 2015;53:374–9. https://doi.org/10.1097/MLR.0000000000000326.CrossRefPubMedPubMedCentral

26.

Simard M, Sirois C, Candas B. Validation of the combined comorbidity index of Charlson and Elixhauser to predict 30-day mortality across ICD-9 and ICD-10. Med Care. 2018;56:441–7. https://doi.org/10.1097/MLR.0000000000000905.CrossRefPubMed

27.

Gologorsky Y, Knightly JJ, Lu Y, Chi JH, Groff MW. Improving discharge data fidelity for use in large administrative databases. Neurosurg Focus. 2014;36:E2. https://doi.org/10.3171/2014.3.FOCUS1459.CrossRefPubMed

28.

Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Eff Clin Pract. 2002;5:143–51.PubMed

Title: Predictors of In-Hospital Mortality and Home Discharge in Patients with Aneurysmal Subarachnoid Hemorrhage: A 4-Year Retrospective Analysis
Authors: Uma V. Mahajan
Hammad A. Khan
Xiaofei Zhou
Shaarada Srivatsa
Christina H. Wright
Adam H. Bates
Martha Sajatovic
Nicholas C. Bambakidis
Publication date: 16-09-2022
Publisher: Springer US
Keywords: Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Published in: Neurocritical Care / Issue 1/2023
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-022-01596-y

2024 ASCO Annual Meeting

Springer Medicine

Predictors of In-Hospital Mortality and Home Discharge in Patients with Aneurysmal Subarachnoid Hemorrhage: A 4-Year Retrospective Analysis

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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