Introduction: The prevalence of obesity is rapidly increasing; however, recent studies have suggested obesity may be protective for those with aneurismal subarachnoid hemorrhage. This is the first national study to evaluate the impact of body habitus on the outcomes of patients with aneurismal subarachnoid hemorrhage.
Methods: Data from the Nationwide Inpatient Sample (2002-2010) were retrospectively extracted. Patients were included who had a diagnosis of subarachnoid hemorrhage and underwent procedural aneurysm repair. Multivariate logistic regression analyses were performed to calculate the adjusted odds of in-hospital mortality and a non-routine hospital discharge for obese patients (with a body mass index between 30.0 kg/m2 and 40.0 kg/m2) and morbidly obese patients (with a body mass index greater than 40.0 kg/m2) compared to non-obese patients. Length of hospital stay and the odds of undergoing tracheostomy, gastrostomy, or ventricular shunting were also evaluated. All analyses were adjusted for differences in patient age, gender, co-morbidities, expected primary payer, treatment modality, ventriculostomy, mechanical ventilation, intraparynchemal hemorrhage, as well as hospital volume, bed size, and teaching status.
Results: 18,104 hospital admissions were examined. Neither obese (OR: 0.82, 95% CI: 0.59, 1.13) nor morbidly obese (OR: 0.84, 95% CI: 0.56, 1.27) patients had significantly different adjusted odds of in-hospital death, compared to non-obese patients. Additionally, length of hospital stay and the likelihood of undergoing tracheostomy, gastrostomy, or ventricular shunting did not vary based on body habitus. Morbidly obese patients (OR: 1.46, 95% CI: 1.08, 1.97), but not obese patients, had an increased adjusted odds of non-routine hospital discharge. Subgroup analyses evaluating patients treated with microsurgical clipping or endovascular coiling separately did not find differential outcomes by body habitus.
Conclusions: In this nationwide study evaluating patients with subarachnoid hemorrhage, morbidly obese patients were found to have higher rates of nonroutine hospital discharge, but no differences in in-hospital mortality was seen by body habitus.
Patient Care: This study improves patient care by showing that obese and morbidly obese patients can safely undergo aneurysm repair after subarachnoid hemorrhage.
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe prior research on the impact of body habitus on subarachnoid hemorrhage; 2) evaluate the findings from the nationwide impatient sample investigating the impact of body habitus on outcomes after aneurysm repair; and 3) analyze the data from this study examining how treatment modality impacts the outcomes by body habitus.