Abstract T P239: Utilization and Outcomes of Ventriculostomy in Non-Traumatic Intracerebral Hemorrhage During Last Decade in United States

Abstract

Background: Large studies describing recent trends in ventriculostomy utilization in non-traumatic ICH are lacking. Purpose: To describe trends, outcomes and predictors of ventriculostomy utilization in ICH. Study-design and Setting: Population based serial cross-sectional study of non-federal US hospitals from 2001-2010. Methods: Nationwide Inpatient Sample was searched for patients with primary diagnosis of ICH (ICD-9 code 431) undergoing ventriculostomy (ICD-9 code 02.2). Primary outcome measures were inpatient mortality and good functional outcomes as indicated by discharge to home. Resource utilization was measured by length of stay and inflation adjusted cost of care (2013 US dollar value). Logistic regression was used to identify independent predictors of ventriculostomy utilization. Population estimates were obtained by complex sample analysis taking into account the discharge weights, clustering and stratification used for sampling design. Results: A total of 652,738 ICH cases were included, of which 41,235 (6.3%) underwent ventriculostomy. The rate of ventriculostomy increased from 5.4% in 2001 to 7.5% in 2010 (trend p <0.001). Predictors of higher ventriculostomy utilization were younger age, male gender, African-American ethnicity, lower Charlson comorbidity index, larger bed-size, urban location, teaching status, western US and more recent calendar year. Patient requiring ventriculostomy had higher inpatient mortality (40.2% vs. 28.1%, p<0.001) and lower rate of good outcome (7.2% vs. 20.0%, p<0.001). They also had longer length of stay (mean +/- SE: 19.2 +/- 0.3 vs. 7.2 +/- 0.1 days; p<0.001) and incurred higher cost of care (USD 57,420 +/- 1,073 vs. 16,438 +/- 221; p<0.001). Patient requiring early ventriculostomy (within 24 hours of admission) had increased mortality compared to those with late ventriculostomy (44.9% vs 32.8%, p<0.001). Inpatient mortality in patients undergoing ventriculostomy decreased from 45.5% in 2001 to 37.7% in 2010 (trend p <0.001). Conclusions: Patients requiring ventriculostomy in non-traumatic ICH have worse outcomes and higher resource utilization. Utilization of ventriculostomy for ICH increased and the mortality decreased in US hospitals during the last decade.