The Nationwide Burden of Neurological Conditions Requiring Emergency Neurosurgery.
BACKGROUND
Neurosurgical emergencies are an important cause of disability and mortality.


OBJECTIVE
To examine the nationwide burden of neurological conditions requiring emergency neurosurgery.


METHODS
The Nationwide Inpatient Sample database (2002-2011) was queried to identify adult patients with a primary discharge diagnosis of a neurosurgical condition who were admitted urgently/emergently or through a trauma center and underwent surgical intervention within 2 days of admission. Diagnostic groups were ranked based on their inpatient complication and mortality burden, and their contribution to total complications, deaths, hospital charges, and length of stay (LOS) was assessed. All analyses were weighted to produce national estimates.


RESULTS
After application of discharge weights, 810 404 patients who underwent emergency neurosurgery were identified. The average complication rate for the entire sample was 8.8%, the mortality rate was 11.2%, average charges were $106 802, and average LOS was 9.0 days. The top 4 diagnostic groups ranked by complication/mortality burden accounted for 76% of all complications, 96% of all deaths, 81% of all charges, and 82% of all days in the hospital for the entire study sample. This was equal to 62 648 complications, 86 683 deaths, $69 billion in charges, and 5962 932 days. These 4 diagnostic groups included (1) acute cerebrovascular disease, (2) intracranial injury, (3) spinal cord injury, and (4) occlusion or stenosis of precerebral arteries.


CONCLUSIONS
Acute cerebrovascular disease, intracranial injury, spinal cord injury, and occlusion/stenosis of precerebral arteries requiring emergency neurosurgery carry an important nationwide burden in terms of complications, deaths, charges, and LOS. Efforts in prevention and/or treatment of these conditions should continue.
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.|Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Rafael
R
De la Garza Ramos
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
C Rory
CR
Goodwin
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Jonathan
J
Nakhla
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Rani
R
Nasser
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Reza
R
Yassari
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Eugene S
ES
Flamm
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ali
A
Bydon
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Geoffrey
G
Colby
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Daniel M
DM
Sciubba
D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies
Carotid stenosis; Emergency neurosurgery; Intracranial injury; Metastatic disease; Nationwide Inpatient Sample; Nationwide burden; Spinal cord injury; Stroke