Patient risk factors and outcomes of vasospasm following aneurysmal subarachnoid hemorrhage: A propensity-score matched analysis

Abstract

Background: Vasospasm is a serious complication following subarachnoid hemorrhage (SAH) secondary to an 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 associated with vasospasm following an aneurysmal SAH and develop a predictive model for the risk of vasospasm.

Methods: The national inpatient sample was used to identify patients admitted with SAH secondary to intracranial aneurysm rupture. The eligible patients were divided based on the incidence of vasospasm during hospital admission, identified using ICD-10-CM diagnosis codes and fluoroscopy for confirmation. A propensity-score 3:1 matching approach was used to balance baseline characteristics, and multivariate logistic regression was performed to identify independent risk factors.

Results: We identified 29,484 patients with aneurysmal SAH in the database. 1,913 suffered vasospasm and 27,571 did not suffer vasospasm. 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.