Shannon M Fernando1,2, Peter M Reardon1,2, Dar Dowlatshahi3,4, Shane W English1,4, Kednapa Thavorn4,5, Peter Tanuseputro4,6,7, Jeffrey J Perry2,4, Erin Rosenberg1, Eelco F Wijdicks8, Daren K Heyland9, Kwadwo Kyeremanteng1,4,7. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 5. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 6. Bruyere Research Institute, Ottawa, ON, Canada. 7. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 8. Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN. 9. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Abstract
OBJECTIVES: Spontaneous intracranial hemorrhage, including subarachnoid hemorrhage and intracerebral hemorrhage, is associated with significant morbidity and mortality. Although many of these patients will require ICU admission, little is known regarding their outcomes and the costs incurred. We evaluated this population in order to identify outcomes and cost patterns. DESIGN: Retrospective cohort analysis of a health administrative database. SETTING: Two ICUs within a single hospital system. PATIENTS: Eight-thousand four-hundred forty-seven patients admitted to ICU from 2011 to 2014, of whom 332 had a diagnosis of spontaneous intracranial hemorrhage. Control patients were defined as randomly selected age, sex, and comorbidity index-matched nonintracranial hemorrhage ICU patients (1:4 matching ratio). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean age of ICU intracranial hemorrhage patients was 60.1 years, and 120 (36.1%) died prior to discharge. Intracranial hemorrhage was associated with a mean total cost of $75,869, compared with $52,471 in control patients (p < 0.01). Mean cost per survivor of intracranial hemorrhage patients was $118,813. Subarachnoid hemorrhage was associated with significantly higher mean total costs than intracerebral hemorrhage ($92,794 vs $53,491; p < 0.01) and higher mean cost per day ($4,377 vs $3,604; p < 0.01). Patients with intracranial hemorrhage who survived to hospital discharge were significantly costlier than decedents ($100,979 vs $30,872; p < 0.01). Intracranial hemorrhage associated with oral anticoagulant use had a mean total cost of $152,373, compared with $66,548 in nonoral anticoagulant intracranial hemorrhage (p < 0.01). CONCLUSIONS: Patients admitted to ICU with intracranial hemorrhage have high costs and high mortality, leading to elevated cost per survivor. Subarachnoid hemorrhage patients incur greater costs than intracerebral hemorrhage patients, and oral anticoagulant-associated intracerebral hemorrhage is particularly costly. Our findings provide novel information regarding financial impact of this common ICU population.
OBJECTIVES: Spontaneous intracranial hemorrhage, including subarachnoid hemorrhage and intracerebral hemorrhage, is associated with significant morbidity and mortality. Although many of these patients will require ICU admission, little is known regarding their outcomes and the costs incurred. We evaluated this population in order to identify outcomes and cost patterns. DESIGN: Retrospective cohort analysis of a health administrative database. SETTING: Two ICUs within a single hospital system. PATIENTS: Eight-thousand four-hundred forty-seven patients admitted to ICU from 2011 to 2014, of whom 332 had a diagnosis of spontaneous intracranial hemorrhage. Control patients were defined as randomly selected age, sex, and comorbidity index-matched nonintracranial hemorrhage ICU patients (1:4 matching ratio). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean age of ICU intracranial hemorrhagepatients was 60.1 years, and 120 (36.1%) died prior to discharge. Intracranial hemorrhage was associated with a mean total cost of $75,869, compared with $52,471 in control patients (p < 0.01). Mean cost per survivor of intracranial hemorrhagepatients was $118,813. Subarachnoid hemorrhage was associated with significantly higher mean total costs than intracerebral hemorrhage ($92,794 vs $53,491; p < 0.01) and higher mean cost per day ($4,377 vs $3,604; p < 0.01). Patients with intracranial hemorrhage who survived to hospital discharge were significantly costlier than decedents ($100,979 vs $30,872; p < 0.01). Intracranial hemorrhage associated with oral anticoagulant use had a mean total cost of $152,373, compared with $66,548 in nonoral anticoagulant intracranial hemorrhage (p < 0.01). CONCLUSIONS:Patients admitted to ICU with intracranial hemorrhage have high costs and high mortality, leading to elevated cost per survivor. Subarachnoid hemorrhagepatients incur greater costs than intracerebral hemorrhagepatients, and oral anticoagulant-associated intracerebral hemorrhage is particularly costly. Our findings provide novel information regarding financial impact of this common ICU population.
Authors: Shannon M Fernando; Danial Qureshi; Peter Tanuseputro; Eddy Fan; Laveena Munshi; Bram Rochwerg; Robert Talarico; Damon C Scales; Daniel Brodie; Sonny Dhanani; Anne-Marie Guerguerian; Sam D Shemie; Kednapa Thavorn; Kwadwo Kyeremanteng Journal: Intensive Care Med Date: 2019-09-16 Impact factor: 17.440
Authors: Abdullah Pandor; Daniel Horner; Sarah Davis; Steve Goodacre; John W Stevens; Mark Clowes; Beverley J Hunt; Tim Nokes; Jonathan Keenan; Kerstin de Wit Journal: Health Technol Assess Date: 2019-12 Impact factor: 4.014
Authors: Alexandre Tran; Shannon M Fernando; Daniel I McIsaac; Bram Rochwerg; Garrick Mok; Andrew J E Seely; Dalibor Kubelik; Kenji Inaba; Dennis Y Kim; Peter M Reardon; Jennifer Shen; Peter Tanuseputro; Kednapa Thavorn; Kwadwo Kyeremanteng Journal: Can J Surg Date: 2020-12-09 Impact factor: 2.089
Authors: Shannon M Fernando; Bram Rochwerg; Peter M Reardon; Kednapa Thavorn; Andrew J E Seely; Jeffrey J Perry; Douglas P Barnaby; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2018-07-06 Impact factor: 9.097
Authors: R Raj; S Bendel; M Reinikainen; S Hoppu; R Laitio; T Ala-Kokko; S Curtze; M B Skrifvars Journal: Crit Care Date: 2018-09-20 Impact factor: 9.097
Authors: Shannon M Fernando; Alison E Fox-Robichaud; Bram Rochwerg; Pierre Cardinal; Andrew J E Seely; Jeffrey J Perry; Daniel I McIsaac; Alexandre Tran; Steven Skitch; Benjamin Tam; Michael Hickey; Peter M Reardon; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2019-02-21 Impact factor: 9.097
Authors: Shannon M Fernando; Rebecca Mathew; Benjamin Hibbert; Bram Rochwerg; Laveena Munshi; Allan J Walkey; Morten Hylander Møller; Trevor Simard; Pietro Di Santo; F Daniel Ramirez; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2020-01-13 Impact factor: 9.097