Waseem Wahood1, Ahraz Ahsan Rizvi2, Alex Yohan Alexander3, Yagiz Ugur Yolcu4, Giuseppe Lanzino3, Waleed Brinjikji3,5, Alejandro A Rabinstein6. 1. Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, 3200 University Drive, Davie, FL, 33328, USA. ww412@mynsu.nova.edu. 2. Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, 3200 University Drive, Davie, FL, 33328, USA. 3. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgery, Mayo Clinic, Rochester, MN, USA. 5. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 6. Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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.
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.
Authors: Patrick Nicholson; Alan O'Hare; Sarah Power; Seamus Looby; Mohsen Javadpour; John Thornton; Paul Brennan Journal: J Neurointerv Surg Date: 2018-10-12 Impact factor: 5.836
Authors: Nima Etminan; Han-Sol Chang; Katharina Hackenberg; Nicolien K de Rooij; Mervyn D I Vergouwen; Gabriel J E Rinkel; Ale Algra Journal: JAMA Neurol Date: 2019-05-01 Impact factor: 18.302
Authors: Roy Poblete; Ling Zheng; Ranjita Raghavan; Steven Cen; Arun Amar; Nerses Sanossian; William Mack; May Kim-Tenser Journal: World Neurosurg Date: 2016-12-27 Impact factor: 2.104
Authors: Charlotte Dandurand; Janny Xue Chen Ke; Rania A Mekary; Swetha Prakash; Gary Redekop; Peter Gooderham; Charles S Haw Journal: J Clin Neurosci Date: 2020-01-21 Impact factor: 1.961