Neurosurgical Fellow Mayo Clinic Rochester, Minnesota, United States
Introduction: Vasospasm is a serious complication following subarachnoid hemorrhage (SAH) secondary to aneurysm rupture. It has been associated with poor clinical outcomes and higher healthcare costs; however, the studies have been limited to relatively small institutional samples. We aimed to identify patient risk factors and outcomes contributing to vasospasm following an aneurysmal SAH, and develop a predictive model for the risk of vasospasm.
Methods: The national inpatient sample (NIS) 2016-2019 was used to identify patients admitted with SAH secondary to an intracranial aneurysm rupture. Patients developing SAH secondary to arteriovenous malformations and trauma were excluded. The eligible patients were divided based on the incidence of vasospasm during hospital admission.
Results: The database reported 1,913 and 27,571 patient records of aneurysmal SAH with and without vasospasm, respectively. The two groups were matched in a 3:1 ratio on baseline patient characteristics and comorbid. The univariate analysis of the matched cohort reported vasospasm is associated with significantly higher risks of ophthalmoplegia (4.9% vs. 2.2%, p< 0.01), need for tracheostomy (11.4% vs. 7.1%, p< 0.01), longer hospital stays (20.6 ± 14.5 vs. 13.0 ± 14.3 days, p< 0.01), non-routine discharge (59.6% vs. 55.4%, p< 0.01), and higher hospital charge (USD 112,800 ± 75,600 vs. 61,000 ± 68,400, p< 0.01). A predictive model for vasospasm was developed using multivariate logistic regression that reported younger age, female sex, private insurance, hypertension, and electrolyte disorders independently associated with the risk of vasospasm following aneurysmal SAH.
Conclusion : Our study reported vasospasm following aneurysmal SAH associated with poor clinical outcomes that cause significant patient morbidity. It also presents a predictive model to assess the risk of vasospasm in patients presenting with aneurysmal SAH.
