Table 3.
Variability in hospital complications and patient outcomes by US Region.
| Variables |
NE (n = 26,519) |
MW (n = 27,166) |
S (n = 38,055) |
W (n = 17,294) |
P value |
|---|---|---|---|---|---|
| Complications and outcomes in subarachnoid hemorrhage patients across the United States (2009-2018) a | |||||
| Complications | |||||
| Hydrocephalus | 8,673 (32.7) | 9,286 (34.2) | 14,437 (37.9) | 6,075 (35) | <0.0001 |
| Delayed cerebral ischemia | 830 (3.1) | 1034 (3.8) | 1024 (2.7) | 737 (4.3) | <0.0001 |
| Seizures/status epilepticus | 4,025 (15.2) | 4,081 (15.0) | 5,515 (14.5) | 2,844 (17) | <0.0001 |
| Cerebral edema | 7,304 (27.5) | 7,099 (26.1) | 13,382 (35.2) | 5,043 (29) | <0.0001 |
| Cerebral ventriculitis | 637 (2.4) | 785 (2.9) | 1,084 (2.9) | 655 (3.8) | <0.0001 |
| Cardio-pulmonary complications | 11,836 (44.6) | 12,974 (47.8) | 18,877 (49.6) | 8,181 (47) | <0.0001 |
| Neurogenic stress cardiomyopathy | 408 (1.5) | 446 (1.6) | 539 (1.4) | 304 (1.8) | 0.0026 |
| Volume/fluid overload | 618 (2.3) | 1,059 (3.9) | 1,156 (3.0) | 676 (3.9) | <0.0001 |
| Acute myocardial infarction | 3,856 (14.5) | 3,968 (14.6) | 4,782 (12.6) | 2,279 (13) | <0.0001 |
| Pulmonary edema | 263 (1.0) | 387 (1.4) | 398 (1.1) | 223 (1.3) | <0.0001 |
| ARDS | 213 (0.8) | 262 (1.0) | 462 (1.2) | 356 (2.1) | <0.0001 |
| Acute respiratory failure | 8,389 (31.6) | 9,272 (34.1) | 14,595 (38.4) | 6,010 (35) | <0.0001 |
| Pulmonary embolism | 527 (2.0) | 623 (2.3) | 704 (1.9) | 366 (2.1) | 0.0009 |
| Deep venous thrombosis | 47 (0.2) | 70 (0.3) | 69 (0.2) | 31 (0.2) | 0.0988 |
| Hyponatremia | 4,811 (18.1) | 5,915 (21.8) | 8,141 (21.4) | 3,841 (22) | <0.0001 |
| Acute kidney injury | 3,160 (11.9) | 3,587 (13.2) | 4,673 (12.3) | 2,418 (14) | <0.0001 |
| Systemic infectious complications | 3,908 (14.7) | 4,138 (15.2) | 5,483 (14.4) | 3,112 (18) | <0.0001 |
| Aspiration pneumonia | 1,135 (4.3) | 977 (3.6) | 1,306 (3.4) | 954 (5.5) | <0.0001 |
| Sepsis | 1,649 (6.2) | 1,807 (6.7) | 2,436 (6.4) | 1373 (7.9) | <0.0001 |
| Bacteremia | 551 (2.1) | 630 (2.3) | 817 (2.2) | 289 (1.7) | <0.0001 |
| Clostridium difficle enteritis | 607 (2.3) | 646 (2.4) | 692 (1.8) | 450 (2.6) | <0.0001 |
| Discharge outcomes | |||||
| In-Hospital mortality | 5,404 (20.4) | 5,304 (19.5) | 7,689 (20.2) | 3,594 (21) | 0.0081 |
| Home | 10,724 (41.0) | 10,999 (41.0) | 17,334 (46.5) | 7,426 (45) | <0.0001 |
| Rehabilitation facility | 5,674 (21.7) | 5173 (19.3) | 6278 (16.8) | 2413 (15) | <0.0001 |
| Skilled nursing facility | 2,743 (10.5) | 3,169 (11.8) | 3,145 (8.4) | 2,027 (12) | <0.0001 |
| Long-term acute care | 735 (2.8) | 1,212 (4.5) | 1,408 (3.8) | 491 (3.0) | <0.0001 |
| Hospice | 826 (3.2) | 922 (3.4) | 1,326 (3.6) | 380 (2.3) | <0.0001 |
| Unknown/other | 24 (0.1) | 67 (0.3) | 97 (0.3) | 48 (0.3) | <0.0001 |
| NIS-SOM poor outcomeb | 10,710 (40.4) | 11,337 (41.7) | 15,085 (39.6) | 6,987 (40) | <0.0001 |
| Length of hospital stay, mean (SD), days | 14.23 (19.7) | 13.60 (13.3) | 14.42 (16.6) | 15.66 (19.2) | <0.0001 |
| Length of ICU stay, mean (SD), days | 8.27 (9.9) | 8.52 (9.7) | 8.84 (10.3) | 9.63 (12.6) | <0.0001 |
| Health-care direct cost, mean (SD), US dollars | 58,574 (93,223) | 57,183 (59,576) | 59,036 (66,179) | 80,379 (98,999) | <0.0001 |
NE, Northeast; MW, Midwest; S, South; W, West; ARDS, Acute Respiratory Distress Syndrome; NIS-SOM, Nationwide Inpatient Sample-Subarachnoid Outcome Measure; SD, Standard Deviation; US, United States. aUnless otherwise specified, values are listed as number and percentage of total number of patients per region; bdefined as discharge to hospice, nursing facility, long-term acute care, death, need for tracheostomy and/or gastrostomy.