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  • Is there a regional disparity in outcome after treatment of cerebral aneurysm? - A United States Nationwide Inpatient Sample (NIS) Database Study.

    Final Number:

    Ashish Sonig MD MCh neurosurgery; Jai D. Thakur MD; Rishi Kumar Wadhwa MD; Imad S. Khan MD; Anil Nanda MD FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: There is paucity of data in the literature about the Impact of Hospital-Related factors on outcome after treatment of Cerebral Aneurysms. Patient’s outcome is not only affected by clinical factors or treatment modalities but also by hospital related factors. We tried to study various hospital factors and their impact on the discharge disposition.

    Methods: The NIS database was studied for the patients admitted for ruptured and unruptured aneurysm from the year 2005-2009.Patients who had their primary diagnosis as SAH or unruptured aneurysm and who underwent either clipping or coiling were included in the study. This dataset was analyzed to ascertain the various hospital factors like bed size, teaching status, ownership, hospital region(Figure1), urban or rural location etc. that can affect the outcome. Binary-logistic regression model was used in the analysis and it was adjusted for treatment factors, co-morbidities, age and sex. Discharge disposition ‘routine’ was taken as a measure of good-outcome.

    Results: A total of 19,101 inpatient admissions for were analyzed. South was the region where maximum interventions were done (33.16%)(Table1). 16,877 interventions were done at teaching hospitals (Table2) compared to 2094(10.9&) at non teaching hospitals. Teaching hospitals fared better then the non teaching hospitals and it was significant (p=<0.0001)(Table3).There was also a regional disparity between the outcome (P=<0.0001)(Table4). Binary logistic regression analysis(Table5) was done. Hospital teaching status had a significant independent negative association with poor outcome (p=0.012 and odds ratio(OR) of 0.714).The mid west region also had a negative association towards poor outcome p<0.001 OR 0.642.West region had a positive relationship with poor outcome but was not significant.

    Conclusions: Hospital related factors also play an important role in the outcome of patients following intervention for cerebral aneurysms. In our study teaching status was a predictor for favorable outcome and Mid west zone had a significantly better outcome.

    Patient Care: Since this study is a United States population based study, the impact of the results may be of significant public health importance.Our study highlights the regions in united states where the results are not as good when compared to other regions.It will help in better distribution of infrastructure in these regions.

    Learning Objectives: By the conclusion of the session participants should be able to understand the regional disparity that exist in the outcome of these patients.Even hospital related factors accounts for patient outcome


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