1207. Ruptured cerebral aneurysms of the destitute: a healthcare discrepancy of microsurgical outcomes between a university tertiary referral center and county safety net hospital
Authors: Ben Strickland, MD; Ben Strickland; Kristine Ravina, MD; Robert Rennert, MD; Steven Giannotta, MD; Jonathan Russin, MD (Los Angeles, CA)
Socioeconomic status is a known contributor to healthcare discrepancies in the United States. Pathologies requiring significant amounts of resources are most vulnerable. We herein assess if a healthcare discrepancy exists in the ruptured cerebral aneurysm population undergoing microsurgical intervention at our institution, and investigate possible variables contributing to differences in neurologic outcomes.
We retrospectively reviewed medical records of the ruptured intracranial aneurysm patients treated with microsurgical intervention by the two senior authors at our tertiary referral University Hospital (UH) and safety net County Hospital (CH) between 2010-2015. Demographic information, Glasgow coma scale score (GCS), Hunt-Hess (HH) and Fisher grade, aneurysm characteristics, surgical data, modified Rankin scale score (mRS), complications, and disposition were recorded.
73 patients from UH and 58 patients from CH were identified for analysis. There was no statistically significant difference in demographics, Fisher score, presenting GCS, hospital days, aneurysm location, or complications between the two cohorts. Patients at UH had a shorter time duration between rupture and intervention (p <0.001). Although there was higher incidence of radiographic and clinical vasospasm in UH patients, they were two-fold more likely to receive verapamil compared to CH (p<0.05). Further, UH patients had significantly higher dispositions to home or rehabilitation centers (non-skilled nursing facilities) as compared to CH (82% versus 67.3% respectively; p<0.05). UH had superior mRS compared to CH at time of discharge and most recent follow-up, although UH also had a higher percentage of high-grade ruptures (p<0.05).
Limited resource availability in a safety net CH hospital could be a major driving force behind the health care discrepancy found in the ruptured cerebral aneurysm population. Diverting CH funds to increase discharges to rehabilitation facilities and increased availability of operating rooms or angiogram suites could aid in closing this health care disparity gap.