Predictors of Treatment Delay in Aneurysmal Subarachnoid Hemorrhage Patients

J. Manuel Sarmiento; Debraj Mukherjee; Kristin Nosova; Wouter I. Schievink; Michael J. Alexander; Chirag G. Patil; Miriam Aracely Nuno

doi:10.1055/s-0034-1372438

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2015; 76(01): 46-55
DOI: 10.1055/s-0034-1372438

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Predictors of Treatment Delay in Aneurysmal Subarachnoid Hemorrhage Patients

Authors

J. Manuel Sarmiento

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Debraj Mukherjee

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Kristin Nosova

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Wouter I. Schievink

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Michael J. Alexander

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Chirag G. Patil

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
Miriam Aracely Nuno

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States

Abstract

Background and Purpose Expeditious treatment is critical in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to the risk of rebleeding. This study aimed to define predictors of treatment delay among aSAH patients.

Methods A retrospective study of the Nationwide Inpatient Sample database identified patients diagnosed with SAH between 2002 and 2007. Patient's characteristics such as age, gender, race, insurance, SAH severity, treatment (coil versus clip), and other factors were studied. The Cochrane-Armitage test was used to assess delayed care trends by procedure, time of treatment, and hospital volume. Multivariate logistic regression evaluated factors associated with treatment delays.

Results A total of 38,827 patients were admitted between 2002 and 2007; 69.0% were women and 61% were white. The overall median age was 52 years. More patients underwent treatment with surgical clipping than with endovascular coiling (60.4% versus 39.6%, respectively). Overall, 74% of hospital admissions occurred on weekdays; the remaining 26% occurred on weekends. Multivariate analysis revealed that older age (odds ratio [OR]: 1.1; p = 0.0004) and surgical clipping versus endovascular coiling (OR: 1.3; p = 0.02) were independent predictors of delayed treatment (i.e., >2 days from admission). Nonwhite patients experienced greater treatment delays on weekdays compared with white patients (OR: 1.4; p = 0.01). Furthermore, patients treated in low-volume hospitals were significantly more likely to experience delays than those treated in higher volume hospitals (OR: 2.0; p = 0.007).

Conclusions Risk factors associated with treatment delay in aSAH patients include older age, nonwhite race, surgical clipping, and admission to low surgical volume hospitals.

Keywords

treatment delay - timeliness - aneurysmal subarachnoid hemorrhage (aSAH) - hospital volume - weekend effect

Full Text

References

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