title: Association of early post-procedure hemodynamic management with the outcomes of subarachnoid hemorrhage patients.
abstract: Post-procedure hemodynamic management for aneurysmal subarachnoid hemorrhage is controversial because of the paucity of studied patients. Using a Japanese administrative database, we tested whether increased albumin, catecholamine, and volumes of fluid administered between the procedure and the 4th post-procedure day would be associated with outcomes of mortality, consciousness deterioration at discharge and re-intubation between the 5th and 14th post-procedure days. Across 550 hospitals, 5,400 patients were identified who received clipping, wrapping and endovascular coiling within 48 h after admission in 2010. Patient characteristics and the administration of albumin, catecholamine, and volume of fluid normalized by body weight were analyzed among the groups and categorized according to the presence of albumin and catecholamine administered between the procedure and the 4th post-procedure day. The association of early hemodynamic management with outcomes was measured using logistic regression models, through controlling for the preference of early administration of albumin and catecholamine. For the patients, 9.3 % received albumin only, 14.4 % catecholamine only, and 4.9 % both between the procedure and the 4th post-procedure day, while 16.5 % received albumin or catecholamine on other days. Variation in albumin and catecholamine administration was observed. Higher normalized fluid volume, commenced before the 4th post-procedure day, was associated with increased mortality and re-intubation (although with decreased complications), and vice versa between the 4th and 14th post-procedure days. Catecholamine administration was associated with worsened outcomes. Hypervolemic and hypertensive therapies commenced before the 4th post-procedure day require further research to determine whether their associations with outcomes in this administrative data base are causal or not.
authors.affiliation: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. kazu228@basil.ocn.ne.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Koichi B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000639:trends; D019468:Disease Management; D005260:Female; D005440:Fluid Therapy / Q000401:mortality / Q000639:trends; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult