Costs of vasospasm in patients with aneurysmal subarachnoid hemorrhage.
OBJECTIVE
To assess the impact of vasospasm on costs, length of stay, and mortality among inpatients with aneurysmal subarachnoid hemorrhage.


METHODS
We combined hospital accounting and physician billing data for a consecutive cohort of 198 patients who underwent surgical clipping or endovascular coiling for subarachnoid hemorrhage repair. We considered patients with transcranial Doppler (TCD) velocity of 120 cm/s or greater in the middle cerebral artery to have TCD-defined vasospasm and patients with delayed ischemic neurological deficit to have symptomatic vasospasm. We compared outcomes of patients with TCD-defined vasospasm (n = 116) and those without (n = 73) and patients with symptomatic vasospasm (n = 62) and those without (n = 127), adjusting for demographic and clinical characteristics.


RESULTS
In adjusted analyses, the incremental cost attributable to TCD-defined vasospasm was 1.20 times higher (95% confidence interval, 1.06-1.36; P = .004) than for patients without TCD-defined vasospasm. Length of stay was an estimated 1.22 times longer for patients with TCD-defined vasospasm (95% CI, 1.07-1.39; P < .01). For symptomatic vasospasm, adjusted costs were 1.27 times higher (95% CI, 1.12-1.43; P < .001) and length of stay was an estimated 1.24 times longer (95% CI, 1.09-1.40; P < .01) for patients with vasospasm than for those without. There was no significant relationship between either type of vasospasm and in-hospital mortality.


CONCLUSIONS
Patients with subarachnoid hemorrhage and TCD-defined or symptomatic vasospasm incur higher inpatient costs and longer hospital stays than those without vasospasm.
Chou
Chia-Hung
CH
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Reed
Shelby D
SD
Allsbrook
Jennifer S
JS
Steele
Janet L
JL
Schulman
Kevin A
KA
Alexander
Michael J
MJ
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000191:economics* / Q000401:mortality; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000191:economics* / Q000209:etiology* / Q000401:mortality