Abstract WP274: Clinical Outcomes of Vasospasms in Non-Traumatic Subarachnoid Hemorrhage and Racial Disparity in the United States: A 20-year Analysis of the National Inpatient Sample From 2000-2019

Abstract

Background: Cerebral vasospasm in non-traumatic subarachnoid hemorrhage (SAH) is associated with a high rate of morbidity and mortality. We aimed to analyze the clinical outcome of the cerebral vasospasms and characterize the racial disparities in patients with vasospasms over a 20 year period. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with cerebral vasospasm (ICD-9 435.9, ICD-10 I67.84) in non-traumatic SAH (ICD-9 430, ICD-10 I60). Demographics, comorbidities, and outcomes were identified. Functional outcome was categorized in Excellent, Good and Poor. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. Results: Among a total of 67,670 SAH patients, 34,091 (50.3%) with vasospasms were identified. Mean Age was 53.4±13.5 years. Patients with vasospasms had higher Elixhauser Comorbidity Score (8.47 ± 7.86 vs. 7.70 ± 7.77; p<0.001). Patients with seizures were more likely to be White or Hispanic, and to have systemic inflammatory disease, hyperlipidemia and hypertension (all p<0.001). After propensity matching, vasospasm patients were less likely to experience in-hospital mortality (AOR 0.53; 95%CI: 0.47-0.59), likely to have longer hospital stay (3.55 days, 95%CI:3.03-4.07), and had increased hospital charges ($114,108; 95%CI: $102,527-125,688)(all p<0.001). The vasospasm patients were 62.2% White, 15.4% Black, 13.2% Hispanic, and 3.7% Asian. The Hispanic patients had more likelihood to have an excellent outcome (P=0.003). Conclusions: Approximately 50% of patients with non-traumatic SAH experienced vasospasms while hospitalized. Vasospasm is more likely to occur in hypertension and hyperlipidemia patients and is associated with longer hospital stay but less in-hospital mortality. The Hispanic race may have better odds of having an excellent outcome.