Abstract TP529: Regional Variability in the Care of Subarachnoid Hemorrhage (SAH) Patients in the United States

Abstract

Introduction: There is little information regarding the regional variability in care of SAH patients across the US. We hypothesised that variability in clinical care exists across different US regions, which may impact patient outcomes. Methods: We conducted a retrospective observational analysis of a cross-sectional cohort generated from the Vizient Clinical Data Base/Resource Manager TM comprising data from more than 90% of US academic medical centers, 50 health care systems and 200 community hospitals. The participating hospitals were divided into 4 regions: Northeast(NE), Midwest(MW), South(S), West(W). Demographics, co-morbidities, complications, radiological, pharmacological, surgical interventions, outcomes and costs on all SAH patients between 2009 and 2016 were extracted. Means and percentages for each variable were calculated by region. Results: Of 61,946 SAH patients, 62% were female, mean age was 56.8yrs and 62% were white. Highest incidence of SAH was found in S (NE=24%, MW=24%, S=36%, W=16%). Diagnostic neuroimaging was used more commonly in NE and W when compared to the national average (47% vs 44%). In W, aneurysms were more commonly clipped (29% vs 19%). Delayed cerebral Ischemia (DCI) (29% vs 26%) and seizures (15% vs 13%) were more common in W, whereas cerebral edema (33% vs 24%) was more common in S. Vasopressors (65% vs 55%), intra-arterial vasodilators (69% vs 56%) and nimodipine (63% vs 58%) were most commonly used in W, whereas AEDs were most commonly used in MW (63% vs 56%). Hospital mortality was not significantly different(17%) but a higher percentage of patients were discharged to a skilled nursing facility in W (10.9% vs 8.5%).The mean length of stay (NE=16.51, MW=15.17, S=16.59, W=17.49 days) was highest in W. The average total cost was also highest in W when compared to the national average ($96476.71 vs $79884.40). Conclusion: There is significant variability in care of SAH patients across different US regions with highest use of resources occurring in W. Despite this, hospital complications such as DCI, discharge disposition and length of stay were slightly worse in W when compared to other regions. These findings might be related to higher rates of aneurysm clipping observed in W. However, prospective confirmation is needed.