Hypernatremia is associated with poorer outcomes following aneurysmal subarachnoid hemorrhage: a nationwide inpatient sample analysis

IntroductionPrior studies of aneurysmal subarachnoid hemorrhage (SAH) have shown that treatment at teaching institutions and decreased time to surgery are factors that correlate with improved patient outcome. We aimed to individually evaluate the effect of teaching institution treatment on rates of surgical clipping or endovascular coiling.MethodsPatients with SAH treated by either aneurysm clipping or coiling between 2002 and 2010 in the Nationwide Inpatient Sample were analyzed. Time to aneurysm treatment was dichotomized to >3 days or ≤3 days and evaluated by multivariable logistic regression modeling, controlling for patient and hospital covariates. Identified predictors for prolonged time to procedure were compared between the clipping and coiling populations.ResultsBetween 2002 and 2010 there were 90 684 SAH admissions with subsequent clipping and coiling procedures. Treatment at teaching hospitals was associated with faster time to clipping (OR 0.60, 95% CI 0.44 to 0.80, p=0.001) but not coiling procedures (p=0.66). Likewise, older age (≥80 years) was associated with delays to clipping (p<0.05) but not coiling procedures (p>0.05). Patients with delayed time to treatment were associated with increased rates of moderate to severe neurological disability.ConclusionsOlder patients with SAH and those treated at non-teaching hospitals were more likely to have delays to aneurysm clipping procedures. These associations were unique to open surgery as age and hospital teaching status did not affect time to coiling procedures.

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Acute subdural hematomas secondary to aneurysmal subarachnoid hemorrhage confer poor prognosis: a national perspective

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016470 ◽

2020 ◽

pp. neurintsurg-2020-016470

Author(s):

Gurmeen Kaur ◽

Katarina Dakay ◽

Tolga Sursal ◽

Jared Pisapia ◽

Christian Bowers ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Poor Prognosis ◽

Nationwide Inpatient Sample ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

The United States ◽

Subdural Hemorrhage ◽

Subarachnoid Bleeding ◽

Stratified Sample ◽

National Perspective

BackgroundAneurysmal ruptures typically cause subarachnoid bleeding with intraparenchymal and intraventricular extension. However, rare instances of acute aneurysmal ruptures present with concomitant, non-traumatic subdural hemorrhage (SDH). We explored the incidence and difference in outcomes of SDH with aneurysmal subarachnoid hemorrhage (aSAH) as compared with aSAH alone.MethodsRetrospective cohort study from 2012 to 2015 from the National (Nationwide) Inpatient Sample (NIS) (20% stratified sample of all hospitals in the United States). NIS database (2012 to September 2015) queried to identify all patients presenting with aSAH. From this population, the patients with concomitant SDH were identified.ResultsA total of 10 075 patients with both cerebral aneurysms and aSAH were included. Of these, 335 cases of concomitant SDH and aSAH were identified. There was no significant change in the rate of SDH in aSAH over time. SDH with aSAH patients had a mortality of 24% compared with 12% (p=0.003) in the SAH only group, and only 16% were discharged home vs 37% (p=0.003) in the SAH group.ConclusionsThere is a 3.5% incidence of acute SDH in patients presenting with non-traumatic aSAH. Patients with SDH and aSAH have nearly double the mortality, higher rate of discharge to nursing home and rehabilitation, and a significantly lower rate of discharge to home and return to routine functioning. This information is useful in counseling and prognostication of patients with concomitant SDH and aSAH.

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