Treatment of Spontaneous Subarachnoid Hemorrhage: A 20-year National Inpatient Sample Review

Abstract

AbstractBackgroundAneurysmal subarachnoid hemorrhage is a major source of morbidity and mortality, and its management has undergone foundational changes over the last 2 decades. We reviewed the National Inpatient Sample (NIS) to outline the changes in severity of illness, surgical management, and patient outcomes over time.MethodsA retrospective cohort of admissions for spontaneous subarachnoid hemorrhage (SAH) in the NIS from 2001-2020 was reviewed, including those that underwent microsurgical or endovascular surgery to secure a ruptured aneurysm. National incidence was calculated, and multivariable regression was used to identify changes in incidence and outcome through time, segmented by epoch.ResultsReview of the NIS identified 450,723 SAH patients, of which 182,151 underwent surgical aneurysm treatment. The incidence of spontaneous SAH fell −0.127 per 100,000 person-years each year [95%CI: −0.164, −0.0887]). Among patients surgically treated for aneurysmal SAH, the proportion of patients <50 years old fell from 40% to 30% between first and final epochs, and the proportion of those in the lowest stroke scale category, roughly equivalent to Hunt & Hess grade 1 or 2, fell from 68% to 49%. The proportion treated by microsurgery fell from 70% to 23% in favor of endovascular surgery. Hospital mortality among these treated cases was stable at 13% throughout the study period despite increasing illness severity indices. After adjustment, there was a 41% reduction of odds of hospital mortality in the final epoch compared with the first.ConclusionsThe incidence of hospitalization for spontaneous SAH fell between 2001 and 2020. Patients undergoing surgery to secure an aneurysm were more severely ill through time yet experienced a stable hospital mortality rate.