Neurosurgery Blog: Factors and Outcomes Associated With Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage

Friday, August 17, 2012

Factors and Outcomes Associated With Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage

BACKGROUND: Recent studies from selected centers have shown that early surgical treatment of aneurysms in subarachnoid hemorrhage (SAH) patients can improve outcomes. These results have not been validated in clinical practice at large. OBJECTIVE: To identify factors and outcomes associated with timing of ruptured intracranial aneurysm obliteration treatment in patients with SAH after hospitalization in the United States. METHODS: We analyzed the data from the Nationwide Inpatient Sample (2005-2008) for all patients presenting with primary diagnosis of SAH, receiving aneurysm treatment (endovascular coil embolization or surgical clip placement). Early treatment was defined as aneurysm treatment performed within 48 hours and delayed treatment if treatment was performed after 48 hours of admission. RESULTS: Of 32 048 patients with SAH who underwent aneurysm treatment, 24 085 (75.2%) underwent early treatment and 7963 (24.8%) underwent delayed treatment. Female sex (P = .002), endovascular embolization (P < .001), and weekday admission (P < .001) were independent predictors of early treatment. In the early treatment group, patients were more likely discharged with none to minimal disability (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.47) and less likely to be discharged with moderate to severe disability (OR 0.77, 95%CI 0.67-0.87) compared with those in the delayed treatment group. The in-hospital mortality was higher in the early treatment group compared with the delayed treatment group (OR 1.36 95%CI 1.12-1.66). CONCLUSION: Patients with SAH who undergo aneurysm treatment within 48 hours of hospital admission are more likely to be discharged with none to minimal disability. Early treatment is more likely to occur in those undergoing endovascular treatment and in patients admitted on weekdays. ABBREVIATIONS: AHRQ, Agency for Healthcare Research and Quality APR-DRG, All Patient Refined Diagnosis Related Group CI, confidence interval HCUP, Healthcare Cost and Utilization Project ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification ISAT, International Subarachnoid Aneurysm Trial NIS, Nationwide Inpatient Sample SAH, subarachnoid hemorrhage