title: Costs of vasospasm in patients with aneurysmal subarachnoid hemorrhage.
abstract: 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.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chou
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Allsbrook
authors.forename: Janet L
authors.initials: JL
authors.lastname: Steele
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alexander
mesh_terms: 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