1106. Health Disparities in Timing of Treatment of Aneurysmal Subarachnoid Hemorrhage in the United States

Authors: Stephanie Chen, MD; David McCarthy, BS; Evan Luther, MD; Samir Sur, MD; Marie-Christine Brunet; Dileep Yavagal, MD; Eric Peterson, MD; Robert Starke, MD (Miami, FL)

Introduction

Re-bleeding after aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. The highest risk (up to 13.5%) occurs within the first 24 hours of symptom onset. Accordingly, early treatment via endovascular or open surgery is associated with improved outcomes. Socioeconomic disparities have been shown to affect the treatment of emergent conditions. Thus, in this study we sought to identify disparities associated with increased time to aneurysm treatment in aSAH beyond 24 hours of presentation.

Methods:

International Classification of Diseases, 9th Edition; Clinical Modification codes were used to identify patients with aSAH who were treated by either surgical clipping or endovascular embolization from the National Inpatient Sample from 2004 to 2014. Delayed treatment was defined as treatment occurring 2 days after admission or later. Elixhauser comorbidities, hospital characteristics, and patient demographics were analyzed via univariate and multivariate logistic regression analyses.

Results

89,192 ruptured aneurysms were treated between 2004 to 2014 in the United States (44,745 surgery, 44,447 endovascular). Overall, 25.3% of patients received delayed treatment (27.8% of clipped, 22.7% of endovascular). Clipping was more likely to be delayed than coiling (OR 1.4 p<0.0001). However, over the decade, there was an increasing proportion of clipped patients treated within 1 day of presentation, while there was no change in the endovascular cohort. Independent predictors of delayed treatment also included: young age (p<0.0001), male gender (OR 1.2 P<0.0001), and non-teaching status of hospital (OR 1.1 p<0.0017). Compared to the Caucasians, Hispanic (OR 1.32, p<0.0001) and Asian race (OR 1.37, p=0.01) were associated with late treatment. Compared to privately insured patients, Medicare, Medicaid, and self-paid patients were also significantly more delayed (OR 1.4, 1.2, 1.1; p=0.0001, 0.0001, 0.005; respectively).

Conclusion

Procedure type, race, as well as socioeconomic factors were all associated with delayed treatment of ruptured aneurysms in the United States