Predictors of hospital-associated complications prolonging ICU stay in patients with low-grade aneurysmal subarachnoid hemorrhage

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  • 1 Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
  • 2 Department of Neurosurgery, University of Florida, Gainesville, Florida;
  • 3 Department of Neurosurgery, University of Washington, Seattle, Washington; and
  • 4 Department of Neurosurgery, University of Miami, Miami, Florida
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OBJECTIVE

The authors sought to determine the predictors of late neurological and hospital-acquired medical complications (HACs) in patients with low-grade aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

The authors conducted a retrospective study of 424 patients with low-grade aSAH admitted to their institution from 2008 to 2015. Data collected included patient comorbidities, Hunt and Hess (HH) grade, ICU length of stay (LOS), and complications. A logistic regression analysis was performed to determine the predictors for neurological and hospital-associated complications.

RESULTS

Out of 424 patients, 50 (11.8%) developed neurological complications after the first week, with a mean ICU stay of 16.3 ± 6.5 days. Of the remaining 374 patients without late neurological complications, 83 (22.2%) developed late HACs with a mean LOS of 15.1 ± 7.6 days, while those without medical complications stayed 11.8 ± 6.2 days (p = 0.001). Of the 83 patients, 55 (66.3%) did not have any HACs in the first week. Smoking (p = 0.062), history of cardiac disease (p = 0.043), HH grade III (p = 0.012), intraventricular hemorrhage (IVH) (p = 0.012), external ventricular drain (EVD) placement (p = 0.002), and early pneumonia/urinary tract infection (UTI)/deep vein thrombosis (DVT) (p = 0.001) were independently associated with late HACs. Logistic regression showed early pneumonia/UTI/DVT (p = 0.026) and increased HH grade (p = 0.057) to be significant risk factors for late medical complications.

CONCLUSIONS

While an extended ICU admission allows closer monitoring, low-grade aSAH patients develop HACs despite being at low risk for neurological complications. The characteristics of low-grade aSAH patients who would benefit from early discharge are reported in detail.

ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; CDI = Clostridium difficile infection; DVT = deep vein thrombosis; EVD = external ventricular drain; HAC = hospital-acquired medical complication; HH = Hunt and Hess; ICP = intracranial pressure; IPH = intraparenchymal hemorrhage; IVH = intraventricular hemorrhage; LOS = length of stay; mRS = modified Rankin Scale; PEG = percutaneous endoscopic gastrostomy; UTI = urinary tract infection.

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Contributor Notes

Correspondence Stavropoula I. Tjoumakaris: Thomas Jefferson University Hospital, Philadelphia, PA. stavropoula.tjoumakaris@jefferson.edu.

INCLUDE WHEN CITING Published online May 3, 2019; DOI: 10.3171/2019.1.JNS182394.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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