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A Nationwide Analysis of Aneurysmal Subarachnoid Hemorrhage Mortality, Complications, and Health Economics in the USA

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Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurological condition. Endovascular coiling or surgical clipping have equivocal success rates, but relatively little is known regarding the health economics and complications of these procedures at the population level. We aimed to analyze the complication profiles and healthcare resource utilization (HRCU) associated with the treatment of aSAH in the USA. We performed a retrospective analysis utilizing the IBM MarketScan database between 2008 and 2015. Primary outcomes included economic analysis stratified by post-operative complication; determination of the effect of several factors on total cost by multivariable regression; and analysis of the incidence, timing, and associated HCRU of aSAH-related post-operative complications. Of the 2374 patients meeting inclusion criteria for economic analysis, 1783 (75.1%) patients had at least one of the ten complications. The most common complications included hydrocephalus (43.8%), transient cerebral ischemia (including vasospasm) (30.6%), ischemic stroke (29.1%), syndrome of inappropriate antidiuretic hormone (SIADH)/hyposmolarity/hyponatremia (22.1%), and seizures (14.9%). Patients who experienced complications had higher median 90-day total costs [$161,127 (Q1 to Q3, $101,411 to $257,662)] than those who did not [$97,376 (Q1 to Q3, $55,692 to $147,447)]. Length of stay was longest for those with pulmonary embolism and pneumonia (27 days) and shortest for those with SIADH/hyposmolarity/hyponatremia (16 days). Brain compression/herniation had the highest mortality rate (19.5%). In total, 14.6% of all patients experienced a readmission within 30 days. In conclusion, patients with aSAH have high post-operative complication rates and costs. Development of novel interventions to reduce complications and improve outcomes is crucial.

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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the sensitive nature of the data. Specifically, this was queried from the IBM MarketScan database which is privately held and requires a paid subscription to access. Additionally, the queried data is exported and analyzed in an encrypted virtual workstation held at the institution performing the research. The data and analysis can be made available from the corresponding author on reasonable request.

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Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553. 

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA

    Lefko T. Charalambous, Syed M. Adil, Shashank Rajkumar, Robert Gramer, Elayna Kirsch, Ali Zomorodi & Shivanand P. Lad

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Beiyu Liu

  3. Duke-Robert J. Margolis Center for Health Policy, Duke University, Box 3807, Durham, NC, 27710, USA

    Mark McClellan & Shivanand P. Lad

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  1. Lefko T. Charalambous
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  2. Syed M. Adil
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Correspondence to Lefko T. Charalambous or Shivanand P. Lad.

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This study was declared exempt from Institutional Review Board approval as it does not report private health information.

Conflict of Interest

SPL is a consultant for Abbott, Boston Scientific, Higgs Boson Health, Medtronic, Minnetronix, Nevro, and Presidio Medical. SMA and LTC are consultants for Higgs Boson Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors report no conflicts of interest.

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Portions of this work have been previously presented as a poster at the AANS annual meeting in San Diego, CA, in April of 2019.

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Charalambous, L.T., Adil, S.M., Rajkumar, S. et al. A Nationwide Analysis of Aneurysmal Subarachnoid Hemorrhage Mortality, Complications, and Health Economics in the USA. Transl. Stroke Res. 14, 347–356 (2023). https://doi.org/10.1007/s12975-022-01065-w

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