Factors associated with increased inpatient charges following aneurysmal subarachnoid hemorrhage with vasospasm: A nationwide analysis

Background: Cerebral vasospasm, following aneurysmal subarachnoid hemorrhage (aSAH), can have high-cost implications for inflicted individuals and their families. To our knowledge, factors associated with high inpatient charges have not been explored. We aimed to address this gap.

Methods: The National Inpatient Sample (NIS) was queried between 2016 and 2018 to identify patients with vasospasm following aSAH. Patients in the upper quartile of charges were identified and analyzed using univariate and multivariate analyses for significant contributing variables.

Results: We identified 1861 patients with aSAH complicated by vasospasm. Multivariate analysis revealed ten statistically significant variables as independent risk factors in association with higher charges. Patients were more likely to be in the upper quartile of charge when younger (OR 0.99 [0.99-0.98]; p < 0.01), a never smoker (OR 1.38 [1.04-1.83]; p < 0.05), concurrent congestive heart failure (OR 1.63 [1.05-2.54]; p < 0.05), requiring VP shunt placement (OR 2.29 [1.68-3.14]; p < 0.001) or tracheostomy (OR 3.05 [2.22-4.18]; p < 0.001), on mechanical ventilation (OR 1.90 [1.40-2.58]; p < 0.001), paralysis (OR 1.34 [1.04-1.74]; p < 0.05) or neurological deficit (OR 1.59 [1.24-2.03]; p < 0.001) as a complication, and being Hispanic (OR 1.89 [1.36-2.64]; p < 0.001) or "other" (OR 1.76 [1.08-2.88]; p < 0.05) for race.

Conclusion: Our study elucidates several factors, from certain demographics and requiring adjunctive mechanical support to several procedures, that may contribute to the high-cost implications faced by aSAH patients suffering vasospasm. While many of these factors may not be unexpected, further research is warranted to help elucidate controllable factors and develop trials to identify early interventions to reduce the financial burden on such patients.