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Length of hospital stay in aneurysmal subarachnoid hemorrhage patients without vasospasm on angiography: potential for a fast-track discharge cohort
  1. Joshua S Catapano,
  2. Visish M Srinivasan,
  3. Kavelin Rumalla,
  4. Mohamed A Labib,
  5. Candice L Nguyen,
  6. Tyler S Cole,
  7. Jacob F Baranoski,
  8. Caleb Rutledge,
  9. Redi Rahmani,
  10. Michael T Lawton,
  11. Andrew F Ducruet,
  12. Felipe C Albuquerque
  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA; Neuropub{at}barrowneuro.org

Abstract

Background Patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.

Methods All aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.

Results A total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5–7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).

Conclusion Lack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.

  • aneurysm

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Footnotes

  • Contributors JSC–writing, concept, data collection; VMS–editing; KR–statistical analysis; MAL–editing; CLN–data collection; TSC–statistical analysis; JFB–data collection; CR–data collection; RR–editing; MTL–editing; AFD–editing; and FCA–editing, final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests Drs AFD and FCA serve on the editorial board of the Journal of NeuroInterventional Surgery. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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