Abstract Details

Title Predictors of 30-day readmissions and in-hospital mortality amongst patients admitted with aneurysmal subarachnoid hemorrhage-Insights from National Database

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-045

Objective To evaluate the national incidence and predictors of increased 30-day readmission and in-hospital mortality amongst patients admitted with aneurysmal subarachnoid hemorrhage

Background Aneurysmal SAH is associated with rising incidence and incremental healthcare cost burden, most of it occurring in the inpatient setting, however, limited studies have examined predictors of mortality and 30-day readmissions in this population.

Design/Methods Aneurysmal SAH patients were selected from the Nationwide Readmission Database (NRD) from 2010 to 2014, using ICD-9 codes to identify all patients ≥ 18 years, aSAH secondary to trauma and arteriovenous malformations were excluded. Admissions within 30 days of discharge from index admission were considered as early readmission, and hierarchical multivariate models were used to evaluate predictors of 30-day readmission and mortality.

Results Of 39,913 aneurysmal SAH patients, 4,503 (11.3%) got readmitted within 30 days during study period (Mean age 57.5 years, Female 68.1%). Predictors of early readmissions included incremental age (HR:1.007, 95% CI:1.002-1.011, p=0.008), Diabetes (HR:1.27, 95% CI:1.11-1.45, p <0.001), Intracerebral hemorrhage (HR:1.30, 95% CI:1.13-1.49, p <0.001), Weekend admission (HR:1.14, 95% CI:1.03-1.27, p =0.015), complications such as gastrointestinal (HR:1.33, 95% CI:1.10-1.62, p= 0.004), Renal (HR:1.36, 95% CI:1.12-1.64,p=0.002),Hematologic (HR:1.33, 95% CI:1.14-1.56, < 0.001). Incremental age (HR:1.06, 95% CI:1.03-1.09, p<0.0001), Decompressive craniectomy (HR:7.45, 95% CI:1.54-35.92, p=0.012), complications such as cardiac (HR:5.82, 95% CI:3.38-10.01, p<0.001), Pulmonary (HR:1.76, 95% CI:1.04-2.98, p=0.035), gastrointestinal (HR:1.99, 95% CI:1.02-3.89, p=0.045), and Infectious (HR:2.49, 95% CI:1.46-4.26, p=0.001) complications were predictors of increased mortality during 30 days readmission. Female gender (HR:0.47, 95% CI:0.28-0.77, p=0.003) and larger hospital admission (HR:0.27, 95% CI:0.11-0.65, p=0.003) were predictors of decreased mortality.

Conclusions Our study identifies patients at risk for readmission after aneurysmal SAH. Additional interventions and close follow up targeted at this high-risk population might help to reduce readmissions and associated mortality.

Authors/Disclosures
Sukriye Damla Kara, MD PRESENTER	Dr. Kara has nothing to disclose.
	No disclosure on file
Chirag N. Savani, MD (Tampa General Hospital)	No disclosure on file
Tejinder Singh, MD (Reading Hospital- Towerhealth- Division of Neurology)	Dr. Singh has nothing to disclose.
Xiyan Yi, MD	Dr. Yi has nothing to disclose.
Weizhe Li, MD, PhD	No disclosure on file
William S. Burgin, MD	Dr. Burgin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for VuEssence. Dr. Burgin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Burgin has stock in VuEssence. The institution of Dr. Burgin has received research support from VuEssence. The institution of Dr. Burgin has received research support from Bristol-Myers Squibb. The institution of Dr. Burgin has received research support from ReNeuron.
Swetha Renati, MD (University of South Florida)	Dr. Renati has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Renati has received personal compensation in the range of $500-$4,999 for serving as a NeuroSAE with ��ɫ�� .

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