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  • Does Timely Intervention for Ruptured Aneurysm Affect Outcome? A United States Nationwide Inpatient Sample Database Study

    Final Number:
    343

    Authors:
    Jai D. Thakur MD; Ashish Sonig MD MCh neurosurgery; Prashant Chittiboina MD, MPH; Imad S. Khan MD; Bharat Guthikonda MD; Anil Nanda MD FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The objective of the study was to assess whether transfer or direct admission status and intervention within 24 hours of admission, affects mortality and morbidity in patients with ruptured aneurysm (RA). Socioeconomic factors determining transfer status in such patients are also analyzed.

    Methods: Retrospective study of United States Nationwide Inpatient Sample database for the year 2008 and 2009 was done. Total of 1692 & 2118 admissions for clipping and coiling respectively, for RA were analyzed.

    Results: In the cohort of admissions undergoing clipping for RA, mortality was not significantly different in transfer vs. non-transfer patients (9% vs. 11%, p=0.06), morbidity was higher in the transfer patients (57% vs. 52%, p<0.05); non-transfer status was an independent factor predicting decreased morbidity (p=0.02, OR 0.775, 95% CI 0.62 to 0.96). In patients undergoing coiling for RA, mortality was not significantly different in transfer vs. non-transfer patients (13%% vs. 13.8%, p=0.6), morbidity was higher in the transfer patients (56% vs. 49%, p<0.05); non-transfer status was an independent factor predicting decreased morbidity (p=0.007, OR 0.76, 95% CI 0.62 to 0.92). Among the cohort of coiling group transfer admissions, patients operated after 24 hours of admission had significantly higher mortality rates than those operated within 24 hours (15.5% vs. 9.2%, p<0.05). Patients living in central or fringe counties of metropolitan area of > 1 million population, white race, median household income of $63,000, were independent factors increasing the likelihood of patients with RA to land directly into a primary treating facility without a transfer.

    Conclusions: Transfer status significantly affects outcomes in the patients undergoing treatment for RA. Transfer patients undergoing coiling within 24 hours have significantly lower mortality rates. There exists a socioeconomic disparity concerning the likelihood of patients admitted directly to primary treatment facility without a transfer among the patients requiring intervention for RA.

    Patient Care: Since this study is a United States population based study, the impact of the results may be of significant public health importance. In our study we found that transfer status can significantly influence outcomes in patients with ruptured aneurysm. This study helps to lay foundation for a focused and better characterized randomized studies to address the need of timely intervention.

    Learning Objectives: By the conclusion of this session, participants should be able to understand how does transfer status can affect outcomes among the cohort of patients with ruptured aneurysm from a population based study. Secondly, this study analyzes the socioeconomic factors which may influence the transfer status in emergent conditions like ruptured aneurysm.

    References:

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