Abstract 45: A Comparison of Outcomes with Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage Patients in United States
Objective: To identify factors and outcomes associated with timing of ruptured cerebral aneurysm obliteration treatment in patients with subarachnoid hemorrhage (SAH) after hospitalization in United States.
Background: Recent studies have shown that early surgical treatment of aneurysm in SAH patients can improve outcomes. These results have not been validated in actual clinical practice to date.
Material and Methods: We analyzed the data from Nationwide Inpatient Sample (NIS 2005-2009) 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 of the hemorrhage and delayed treatment was performed after 48 hours. Clinical outcome was defined as minimal or no disability (self-care), moderate to severe disability (extended care facility) based on discharge disposition; and in-hospital death. Multivariate logistic regression analysis was used to identify the predictors of delayed treatment.
Results: Out of the 32,048 patients with SAH who underwent aneurysm treatment, 24,085 (75.2%) underwent early treatment and7,963 (24.8%) underwent delayed treatment. Female gender (p=0.0018), teaching hospital status (p=0.103), endovascular embolization (p<0.0001) and weekday admission (p<0.0001) were independent predictors of early treatment. The mean hospital stay was 17.3 days in early treatment group and 19.7 days in late treatment group (p<0.001). In the early treatment group, patients were more likely to discharge with minimal disability (51.1% vs. 47.1% p=0.004, adjusted OR 1.15, 95% CI 1.03-1.29) and less likely to be discharged with moderate to severe disability (34.4% vs. 41.8% p<0.0001, adjusted OR 0.7, 95% CI 0.67-0.86) as compared with those in the delayed treatment group. The in-hospital mortality was higher in the early treatment group compared with delayed treatment (14% vs. 11%, p=0.001, adjusted OR 1.4 95% CI 1.12-1.67).
Conclusion: Patients with SAH who undergo aneurysm treatment within 48 hours of hospital admission are more likely to be discharged with minimal disability. Early treatment is more likely to occur in teaching hospitals, those undergoing endovascular treatment, and in patients admitted on weekdays.
- © 2012 by American Heart Association, Inc.