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Trends in Admissions and Outcomes for Treatment of Aneurysmal Subarachnoid Hemorrhage in the United States

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Abstract

Background

Lifestyle modifications and advances in surgical and endovascular techniques for treating unruptured intracranial aneurysm (UIA) have vastly evolved over the last few decades and may have reduced the incidence of aneurysmal subarachnoid hemorrhage (aSAH). However, the actual impact of these changes on the rates and outcomes of aSAH remain unexplored. Thus, we studied national aSAH admissions and outcome trends and changes of major risk factors over time.

Methods

We queried the National Inpatient Sample between 2006 and 2018 to identify adult patients admitted and treated for UIA or ruptured aneurysm with aSAH. The Cochran–Armitage test was conducted to assess the linear trend of proportion of prevalence, inpatient mortality, hypertension, and current smoking status among aSAH admissions. Multivariable logistic regression was conducted to assess the odds of presenting with aSAH versus UIA, in addition to the odds of inpatient mortality among patients with aSAH.

Results

A total of 159,913 patients presented with UIA and 133,567 presented with aSAH. Admissions for aSAH decreased by 0.97% (p < 0.001) per year. Current smoking and hypertension were associated with higher odds of being admitted for aSAH compared with the treatment for UIA (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.29–1.48; OR 1.15, 95% CI 1.08–1.22, respectively). Compared with White patients, Black patients (OR 1.32, 95% CI 1.21–1.43), Hispanic patients (OR 1.38, 95% CI 1.25–1.52), and patients of other races and/or ethnicities (OR 1.73, 95% CI 1.54–1.95) had a higher chance of presenting with aSAH. Rates of inpatient mortality among aSAH admissions showed no change over time (p = 0.21). Among patients admitted with aSAH, current smoking and hypertension showed an upward trend of 0.58% (p < 0.001) and 1.60% (p < 0.001) per year, respectively.

Conclusions

Despite a downward trend in the annual frequency of hospitalizations for aSAH, inpatient mortality rates for patients undergoing treatment of the ruptured aneurysm have remained unchanged in the United States. Smoking and hypertension are increasingly prevalent among patients with aSAH. Thus, efforts to control these modifiable risk factors must be further strengthened.

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Authors and Affiliations

  1. Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, 3200 University Drive, Davie, FL, 33328, USA

    Waseem Wahood & Ahraz Ahsan Rizvi

  2. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Alex Yohan Alexander, Giuseppe Lanzino & Waleed Brinjikji

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Yagiz Ugur Yolcu

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Waleed Brinjikji

  5. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Alejandro A. Rabinstein

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  1. Waseem Wahood
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  2. Ahraz Ahsan Rizvi
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  3. Alex Yohan Alexander
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  4. Yagiz Ugur Yolcu
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  5. Giuseppe Lanzino
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  6. Waleed Brinjikji
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  7. Alejandro A. Rabinstein
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Contributions

WW: conception and design, acquisition of data, or analysis and interpretation of data; drafting and revising article. AAR: interpretation of data; drafting and revising article. AYA: drafting and revising article. YUY: revising article. GL: revising article. WB: revising article, supervision. AAR: revising article. The final manuscript was approved by all authors.

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Correspondence to Waseem Wahood.

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No institutional review board approval was required, as the data were deidentified and collected from a national database.

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Wahood, W., Rizvi, A.A., Alexander, A.Y. et al. Trends in Admissions and Outcomes for Treatment of Aneurysmal Subarachnoid Hemorrhage in the United States. Neurocrit Care 37, 209–218 (2022). https://doi.org/10.1007/s12028-022-01476-5

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  • DOI: https://doi.org/10.1007/s12028-022-01476-5

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