Abstract T P403: Permanent Ventricular Shunting In Subarachnoid Hemorrhage And Intracerebral Hemorrhage Patients Requiring Temporary Ventriculostomy

Abstract

Background and Purpose: Aneurysmal subarachnoid hemorrhage (SAH) and spontaneous intracerebral hemorrhage (ICH) frequently lead to obstructive and/or communicating hydrocephalus. A permanent ventricular shunt is required in cases with failure to wean ventriculostomy. Large-scale studies comparing rates of ventricular shunting after SAH and ICH are lacking. Therefore, we studied the rates of shunting among SAH and ICH requiring ventriculostomy. Methods: We analyzed the Nationwide Inpatient Sample, a 20% sample of non-federal hospitalizations in US from 2002 to 2011 to select adults with ICH (ICD-9 code 431) and SAH (430) undergoing ventriculostomy (02.2, 02.21). We excluded patients surviving <7 days after ventriculostomy. We compared rates of ventricular shunting (02.32-02.34) between SAH and ICH after adjusting for baseline characteristics using logistic regression. Population estimates were obtained using sample weighting. Results: 23,541 cases with ICH (median age 59 y) and 31,883 cases with SAH (median age 56 y) were included. Unadjusted shunting rate was higher in SAH compared to ICH (19.9% vs 11.4%, P<0.001), and it remained higher in SAH in multivariate analysis (adjusted OR: 1.69; 95% CI: 1.45-1.98, P<0.001). There was no difference in the interval between ventriculostomy and shunting between SAH and ICH (mean: 18.9 +/- 11.8 [SD] vs 18.1 +/- 10.9 days, P=0.196). Among SAH cases, shunting rate was higher with coiling compared to clipping (23.8% vs 18.1%, P<0.001). There was a significant trend toward higher shunt utilization over time among SAH patients (16.3% in 2002-03 to 21.4% in 2010-11, trend P<0.001). The shunting rate remained unchanged among ICH patients (11.3% in 2002-03 to 11.5% in 2010-11, trend P=0.363). Patients requiring ventriculostomy within 24 hours of admission comprised 61.8% of all cases, and had higher shunting rate (adjusted OR: 1.17; 95% CI: 1.07-1.28, P=0.001). Conclusions: SAH compared to ICH has higher rates of failure to wean ventriculostomy requiring permanent ventricular shunting. Increasing trend in shunt utilization after SAH is co-incident with increase in aneurysm coiling during recent years.