Ashish Sonig1,2, Hussain Shallwani1,2, Sabareesh K Natarajan1,2, Hakeem J Shakir1,2, L Nelson Hopkins1,3,4,2,5, Kenneth V Snyder1,6,4,2, Adnan H Siddiqui1,3,4,2,5, Elad I Levy1,3,4,2. 1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sci-ences, University at Buffalo, State Uni-versity of New York, Buffalo, New York. 2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo New York. 3. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buf-falo, State University of New York, Buffalo, New York. 4. Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York. 5. Jacobs Institute, Buffalo, New York. 6. Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
Abstract
BACKGROUND: The benefit of surgical treatment of ruptured aneurysms is well established. OBJECTIVE: To determine whether ultra-early ruptured aneurysm treatment leads to not only improved outcomes but also reduced hospitalization cost. METHODS: Using 2008-2011 Nationwide Inpatient Sample data, we analyzed demographic, clinical, and hospital factors for nontraumatic subarachnoid hemorrhage (SAH) patients who were "directly" admitted to the treating hospital where they underwent intervention (clipping/coiling). Patients treated on the day of admission (day 0) formed the ultra-early cohort; others formed the deferred treatment cohort. All Patient Refined Diagnosis-Related Groups were also included in regression analyses. RESULTS: A total of 17 412 patients were directly admitted to a hospital following nontraumatic SAH where they underwent intervention (clipping/coiling). Mean patient age was 53.87 yr (median 53.00, standard deviation 14.247); 68.3% were women (n = 11 893). A total of 6338 (36.4%) patients underwent treatment on the day of admission (ultra-early). Patients who underwent treatment on day 0 had significantly more routine discharge dispositions than those treated >admission day 0 (P < .0001). In regression analysis, treatment on day 0 was protective against other than routine discharge disposition outcome (P < .0001; odds ratio 0.657; 95% confidence interval 0.614-0.838). Total cost incurred by hospitals was $4.36 billion. Mean cost of hospital charges in the ultra-early cohort was $239 126.05, which was significantly lower than that for the cohort treated >day 0 ($272 989.56, P < .001), Mann-Whitney U-test). Performance of an intervention on admission day 0 was protective against higher hospitalization cost (P < .0001; odds ratio 0.811; 95% confidence interval 0.732-0.899). CONCLUSION: Ultra-early treatment of ruptured aneurysms is significantly associated with better discharge disposition and decreased hospitalization cost.
BACKGROUND: The benefit of surgical treatment of ruptured aneurysms is well established. OBJECTIVE: To determine whether ultra-early ruptured aneurysm treatment leads to not only improved outcomes but also reduced hospitalization cost. METHODS: Using 2008-2011 Nationwide Inpatient Sample data, we analyzed demographic, clinical, and hospital factors for nontraumatic subarachnoid hemorrhage (SAH) patients who were "directly" admitted to the treating hospital where they underwent intervention (clipping/coiling). Patients treated on the day of admission (day 0) formed the ultra-early cohort; others formed the deferred treatment cohort. All Patient Refined Diagnosis-Related Groups were also included in regression analyses. RESULTS: A total of 17 412 patients were directly admitted to a hospital following nontraumatic SAH where they underwent intervention (clipping/coiling). Mean patient age was 53.87 yr (median 53.00, standard deviation 14.247); 68.3% were women (n = 11 893). A total of 6338 (36.4%) patients underwent treatment on the day of admission (ultra-early). Patients who underwent treatment on day 0 had significantly more routine discharge dispositions than those treated >admission day 0 (P < .0001). In regression analysis, treatment on day 0 was protective against other than routine discharge disposition outcome (P < .0001; odds ratio 0.657; 95% confidence interval 0.614-0.838). Total cost incurred by hospitals was $4.36 billion. Mean cost of hospital charges in the ultra-early cohort was $239 126.05, which was significantly lower than that for the cohort treated >day 0 ($272 989.56, P < .001), Mann-Whitney U-test). Performance of an intervention on admission day 0 was protective against higher hospitalization cost (P < .0001; odds ratio 0.811; 95% confidence interval 0.732-0.899). CONCLUSION: Ultra-early treatment of ruptured aneurysms is significantly associated with better discharge disposition and decreased hospitalization cost.
Authors: Stephan Waldeck; René Chapot; Christian von Falck; Matthias F Froelich; Marc Brockmann; Daniel Overhoff Journal: J Clin Med Date: 2022-01-28 Impact factor: 4.241
Authors: Christina I Collins; Tasneem F Hasan; Lesia H Mooney; Jessica L Talbot; Amanda L Fouraker; Katherine F Nelson; MaryAnn Ohanian; Stephanie L Bonnett; Rabih G Tawk; Lisa M Nordan; David O Hodge; Robert S Kaplan; Benjamin L Thiemann; Meredith Karney; William D Freeman Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-06-05