Predictors of treatment delay in aneurysmal subarachnoid hemorrhage patients

J. Manuel Sarmiento, Debraj Mukherjee, Kristin Nosova, Wouter I. Schievink, Michael J. Alexander, Chirag G. Patil, Miriam A Nuno

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Expeditious treatment is critical in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to the risk of rebleeding. This study aimed to define predictors of treatment delay among aSAH patients.

METHODS: A retrospective study of the Nationwide Inpatient Sample database identified patients diagnosed with SAH between 2002 and 2007. Patient's characteristics such as age, gender, race, insurance, SAH severity, treatment (coil versus clip), and other factors were studied. The Cochrane-Armitage test was used to assess delayed care trends by procedure, time of treatment, and hospital volume. Multivariate logistic regression evaluated factors associated with treatment delays.

RESULTS: A total of 38,827 patients were admitted between 2002 and 2007; 69.0% were women and 61% were white. The overall median age was 52 years. More patients underwent treatment with surgical clipping than with endovascular coiling (60.4% versus 39.6%, respectively). Overall, 74% of hospital admissions occurred on weekdays; the remaining 26% occurred on weekends. Multivariate analysis revealed that older age (odds ratio [OR]: 1.1; p = 0.0004) and surgical clipping versus endovascular coiling (OR: 1.3; p = 0.02) were independent predictors of delayed treatment (i.e., >2 days from admission). Nonwhite patients experienced greater treatment delays on weekdays compared with white patients (OR: 1.4; p = 0.01). Furthermore, patients treated in low-volume hospitals were significantly more likely to experience delays than those treated in higher volume hospitals (OR: 2.0; p = 0.007).

CONCLUSIONS: Risk factors associated with treatment delay in aSAH patients include older age, nonwhite race, surgical clipping, and admission to low surgical volume hospitals.

Original languageEnglish (US)
Pages (from-to)46-55
Number of pages10
JournalJournal of neurological surgery. Part A, Central European neurosurgery
Volume76
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Subarachnoid Hemorrhage
Low-Volume Hospitals
Odds Ratio
Therapeutics
High-Volume Hospitals
Insurance
Surgical Instruments
Inpatients
Multivariate Analysis
Retrospective Studies
Logistic Models
Databases

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Predictors of treatment delay in aneurysmal subarachnoid hemorrhage patients. / Sarmiento, J. Manuel; Mukherjee, Debraj; Nosova, Kristin; Schievink, Wouter I.; Alexander, Michael J.; Patil, Chirag G.; Nuno, Miriam A.

In: Journal of neurological surgery. Part A, Central European neurosurgery, Vol. 76, No. 1, 01.01.2015, p. 46-55.

Research output: Contribution to journalArticle

Sarmiento, J. Manuel ; Mukherjee, Debraj ; Nosova, Kristin ; Schievink, Wouter I. ; Alexander, Michael J. ; Patil, Chirag G. ; Nuno, Miriam A. / Predictors of treatment delay in aneurysmal subarachnoid hemorrhage patients. In: Journal of neurological surgery. Part A, Central European neurosurgery. 2015 ; Vol. 76, No. 1. pp. 46-55.
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abstract = "BACKGROUND AND PURPOSE: Expeditious treatment is critical in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to the risk of rebleeding. This study aimed to define predictors of treatment delay among aSAH patients.METHODS: A retrospective study of the Nationwide Inpatient Sample database identified patients diagnosed with SAH between 2002 and 2007. Patient's characteristics such as age, gender, race, insurance, SAH severity, treatment (coil versus clip), and other factors were studied. The Cochrane-Armitage test was used to assess delayed care trends by procedure, time of treatment, and hospital volume. Multivariate logistic regression evaluated factors associated with treatment delays.RESULTS: A total of 38,827 patients were admitted between 2002 and 2007; 69.0{\%} were women and 61{\%} were white. The overall median age was 52 years. More patients underwent treatment with surgical clipping than with endovascular coiling (60.4{\%} versus 39.6{\%}, respectively). Overall, 74{\%} of hospital admissions occurred on weekdays; the remaining 26{\%} occurred on weekends. Multivariate analysis revealed that older age (odds ratio [OR]: 1.1; p = 0.0004) and surgical clipping versus endovascular coiling (OR: 1.3; p = 0.02) were independent predictors of delayed treatment (i.e., >2 days from admission). Nonwhite patients experienced greater treatment delays on weekdays compared with white patients (OR: 1.4; p = 0.01). Furthermore, patients treated in low-volume hospitals were significantly more likely to experience delays than those treated in higher volume hospitals (OR: 2.0; p = 0.007).CONCLUSIONS: Risk factors associated with treatment delay in aSAH patients include older age, nonwhite race, surgical clipping, and admission to low surgical volume hospitals.",
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AU - Sarmiento, J. Manuel

AU - Mukherjee, Debraj

AU - Nosova, Kristin

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AU - Alexander, Michael J.

AU - Patil, Chirag G.

AU - Nuno, Miriam A

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N2 - BACKGROUND AND PURPOSE: Expeditious treatment is critical in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to the risk of rebleeding. This study aimed to define predictors of treatment delay among aSAH patients.METHODS: A retrospective study of the Nationwide Inpatient Sample database identified patients diagnosed with SAH between 2002 and 2007. Patient's characteristics such as age, gender, race, insurance, SAH severity, treatment (coil versus clip), and other factors were studied. The Cochrane-Armitage test was used to assess delayed care trends by procedure, time of treatment, and hospital volume. Multivariate logistic regression evaluated factors associated with treatment delays.RESULTS: A total of 38,827 patients were admitted between 2002 and 2007; 69.0% were women and 61% were white. The overall median age was 52 years. More patients underwent treatment with surgical clipping than with endovascular coiling (60.4% versus 39.6%, respectively). Overall, 74% of hospital admissions occurred on weekdays; the remaining 26% occurred on weekends. Multivariate analysis revealed that older age (odds ratio [OR]: 1.1; p = 0.0004) and surgical clipping versus endovascular coiling (OR: 1.3; p = 0.02) were independent predictors of delayed treatment (i.e., >2 days from admission). Nonwhite patients experienced greater treatment delays on weekdays compared with white patients (OR: 1.4; p = 0.01). Furthermore, patients treated in low-volume hospitals were significantly more likely to experience delays than those treated in higher volume hospitals (OR: 2.0; p = 0.007).CONCLUSIONS: Risk factors associated with treatment delay in aSAH patients include older age, nonwhite race, surgical clipping, and admission to low surgical volume hospitals.

AB - BACKGROUND AND PURPOSE: Expeditious treatment is critical in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to the risk of rebleeding. This study aimed to define predictors of treatment delay among aSAH patients.METHODS: A retrospective study of the Nationwide Inpatient Sample database identified patients diagnosed with SAH between 2002 and 2007. Patient's characteristics such as age, gender, race, insurance, SAH severity, treatment (coil versus clip), and other factors were studied. The Cochrane-Armitage test was used to assess delayed care trends by procedure, time of treatment, and hospital volume. Multivariate logistic regression evaluated factors associated with treatment delays.RESULTS: A total of 38,827 patients were admitted between 2002 and 2007; 69.0% were women and 61% were white. The overall median age was 52 years. More patients underwent treatment with surgical clipping than with endovascular coiling (60.4% versus 39.6%, respectively). Overall, 74% of hospital admissions occurred on weekdays; the remaining 26% occurred on weekends. Multivariate analysis revealed that older age (odds ratio [OR]: 1.1; p = 0.0004) and surgical clipping versus endovascular coiling (OR: 1.3; p = 0.02) were independent predictors of delayed treatment (i.e., >2 days from admission). Nonwhite patients experienced greater treatment delays on weekdays compared with white patients (OR: 1.4; p = 0.01). Furthermore, patients treated in low-volume hospitals were significantly more likely to experience delays than those treated in higher volume hospitals (OR: 2.0; p = 0.007).CONCLUSIONS: Risk factors associated with treatment delay in aSAH patients include older age, nonwhite race, surgical clipping, and admission to low surgical volume hospitals.

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