1154. National Trends in Neurosurgical Procedures by Race and Ethnicity among Hospitalizations for Spontaneous Intracerebral Hemorrhage

Authors: Roxanna Garcia, MD; Hannah Weiss, BA; William Metcalf-Doestch, MD; Pedram Golnari, MD; Pouya Nazari, MD; Shyam Prabhakaran; Andrew Naidech; Babak Jahromi (Chicago, IL)

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a deadly form of stroke. Since the release of the Surgical Trial in Lobar Intracerebral Haemorrhage trials in 2005, utilization of life-saving neurosurgical procedures (ventriculostomy or open cranial surgery) has not been described in the literature and little is known regarding racial and ethnic disparities. Methods: Hospitalizations from the National Inpatient Sample between 2007 to 2015 were identified and a time trend analysis by racial and ethnic subgroup was performed. A hierarchical multivariable logistic regression with survey weights was implemented to evaluate the association between race and ethnicity with the likelihood of undergoing ventriculostomy or open cranial surgery. Results: A total of 121,305 hospitalizations were identified with 21,255 ventriculostomies (17.52%) and 8,597 open cranial surgeries (7.09%) performed. The white subgroup underwent the highest proportion of ventriculostomy placement (68.94%, p-value <0.0001) and open cranial surgeries (68.83%, p-value <0.0001). A time trend analysis stratified by procedure type, gender, and age did not demonstrate significant differences between 2007 and present by racial and ethnic subgroups. Ventriculostomy was not associated with racial and ethnic subgroups in multivariable analysis, but compared to whites, Hispanics had a higher odds of undergoing open cranial surgery after adjustment for confounders including disease severity (OR:1.29, p-value=0.05, 95% CI: 1.0-1.68, area under curve 0.84, 95% CI: 0.84-0.85). Predictors associated with increased odds of ventriculostomy or cranial surgery included disease severity, teaching status, bedsize, and insurance status. There were no differences in inpatient mortality by race and ethnicity. Conclusion: There are no differences in utilization of EVD from 2007 to 2015 for spontaneous ICH, but there is a non-significant trend towards increased odds of open cranial surgeries among Hispanics compared to whites.