Abstract TP126: Rising Incidence Of Hydrocephalus In Patients With Intracerebral Hemorrhage In 20-year Analysis Of The National Inpatient Sample

Abstract

Introduction: Hydrocephalus (HCP) is a common consequence of intracerebral hemorrhage (ICH) and is a predictor of poor outcomes in ICH patients. We aimed to characterize ICH patients with HCP and assess their clinical outcomes over a 20-year period. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of hydrocephalus on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. Results: 2,000,868 patients with ICH were identified; 9.2% had HCP. Patients with HCP had higher NIHSS (17.16±11.13 vs 10.77±9.14) and Elixhauser Comorbidity Score (10.64±8.79 vs. 10.4±9.12) at presentation, longer hospital stays (13.92±18.13 vs 8.13± 11.3 days) and higher hospital charges ($160,604.36± 225,493.62 vs $74,930.99± 137,200.59) (all p<0.001). After propensity matching, HCP patients had higher rates of surgical intervention (including EVD and ventricular shunt placement), and higher tracheostomy and PEG/G-tube requirement (all p<0.001). On multivariate analysis, HCP patients had higher in-hospital mortality (2.21; 95% CI: 1.85-2.65) and lesser likelihood of discharge home or short-term hospital (0.46; 95% CI: 0.35-0.61) (p<0.001). Conclusion: In this 20-year nationally representative propensity matched analysis of patients with ICH, those with concomitant HCP had higher rates of surgical procedures (EVD, ventricular shunt, tracheostomy and PEG). Incidence of HCP increased more than two-fold from2000-2019, suggesting worsening disease severity over the study period.