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Factors associated with increased inpatient charges following aneurysmal subarachnoid hemorrhage with vasospasm: A
William Mualem1, Sulaman Durrani1, Abdul Karim Ghaith1
1Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is costly. Younger age, never smoking, heart failure, VP shunt, tracheostomy, mechanical ventilation, paralysis, neurological deficit, and Hispanic race are linked to higher inpatient charges.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Health Economics
Background:
- Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) presents significant financial burdens.
- Factors contributing to high inpatient charges in these patients remain underexplored.
Purpose of the Study:
- To identify demographic, clinical, and procedural factors associated with elevated inpatient costs in patients with aSAH-related vasospasm.
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database from 2016-2018.
- Identification of patients with aSAH and vasospasm, with subsequent analysis of those in the upper quartile of charges.
- Univariate and multivariate logistic regression to determine risk factors for high charges.
Main Results:
- Ten independent risk factors for higher charges were identified in 1861 patients.
- Factors include younger age, never smoking, congestive heart failure, VP shunt placement, tracheostomy, mechanical ventilation, paralysis, neurological deficit, and specific racial groups (Hispanic, 'other').
Conclusions:
- Several factors, including demographics, need for mechanical support, and specific procedures, contribute to high costs in aSAH patients with vasospasm.
- Further research is needed to identify controllable factors and develop interventions to mitigate the financial impact.
Background:
Cerebral vasospasm, following aneurysmal subarachnoid hemorrhage (aSAH), can have high-cost implications for inflicted individuals and their families. To our knowledge, factors associated with high inpatient charges have not been explored. We aimed to address this gap.
Methods:
The National Inpatient Sample (NIS) was queried between 2016 and 2018 to identify patients with vasospasm following aSAH. Patients in the upper quartile of charges were identified and analyzed using univariate and multivariate analyses for significant contributing variables.
Results:
We identified 1861 patients with aSAH complicated by vasospasm. Multivariate analysis revealed ten statistically significant variables as independent risk factors in association with higher charges. Patients were more likely to be in the upper quartile of charge when younger (OR 0.99 [0.99-0.98]; p < 0.01), a never smoker (OR 1.38 [1.04-1.83]; p < 0.05), concurrent congestive heart failure (OR 1.63 [1.05-2.54]; p < 0.05), requiring VP shunt placement (OR 2.29 [1.68-3.14]; p < 0.001) or tracheostomy (OR 3.05 [2.22-4.18]; p < 0.001), on mechanical ventilation (OR 1.90 [1.40-2.58]; p < 0.001), paralysis (OR 1.34 [1.04-1.74]; p < 0.05) or neurological deficit (OR 1.59 [1.24-2.03]; p < 0.001) as a complication, and being Hispanic (OR 1.89 [1.36-2.64]; p < 0.001) or "other" (OR 1.76 [1.08-2.88]; p < 0.05) for race.
Conclusion:
Our study elucidates several factors, from certain demographics and requiring adjunctive mechanical support to several procedures, that may contribute to the high-cost implications faced by aSAH patients suffering vasospasm. While many of these factors may not be unexpected, further research is warranted to help elucidate controllable factors and develop trials to identify early interventions to reduce the financial burden on such patients.
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