Healthcare Resource Utilization of Complications of Intracerebral Hemorrhage

Abstract

Abstract INTRODUCTION Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality worldwide, with a 1-mo mortality rate between 30% and 50%. Our goal was to quantify additional healthcare resource utilization (HCRU) incurred by the US health system due to complications sustained during initial ICH hospital admissions, including a cost comparison of complications treated invasively vs noninvasively. METHODS The IBM MarketScan databases were used to retrospectively identify ICH patients and quantify the prevalence and HCRU of associated complications. HCRU variables included total service costs and length of hospital stay (LOS). Complications studied included cerebral edema, hydrocephalus, delayed ischemic stroke, venous thromboembolic events (VTE), infections (urinary tract infection (UTI) and pneumonia), and seizures. Invasive interventions included craniotomies/craniectomies and CSF diversion. Costs were assessed at 7, 30, 60, and 365 d post-ICH diagnosis for complications. RESULTS A total of 29 989 adult patients were included. Of those, 18 387 (61%) developed at least 1 complication during their initial ICH admission: 35% delayed ischemic stroke, 23% cerebral edema, 15% infections, 11% hydrocephalus, 5% seizures, and 5% VTE. Overall median LOS for all ICH was 5 d (IQR 2-10 d). Patients developing VTE had the longest median LOS at 17 d (IQR 8-27 d) and highest 7-d inpatient cost (median $67,222; IQR $24,384-157,919). Hydrocephalus had similar median LOS (15 d; IQR 6-23 d) and second highest median 7-d inpatient cost (median $59,553; IQR $22,129-143,835). Patients suffering cerebral edema, hydrocephalus, or delayed ischemic stroke requiring invasive treatments had higher costs at all times, especially during the first 7 d, with differences ranging from $61,852 for hydrocephalus to $84,699 for delayed ischemic stroke. CONCLUSION Delayed ischemic stroke and cerebral edema were the most common complications during initial ICH admission. VTE and hydrocephalus had the longest LOS and highest service costs at all times after diagnosis.