Inpatient mortality and healthcare resource utilization of nontraumatic intracerebral hemorrhage complications in the US

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  • 1 Departments of Neurosurgery and
  • 2 Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and
  • 3 Minnetronix, Inc., St. Paul, Minnesota
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OBJECTIVE

Nontraumatic, primary intracerebral hemorrhage (ICH) accounts for 2 million strokes worldwide annually and has a 1-year survival rate of 50%. Recent studies examining functional outcomes from ICH evacuation have been performed, but limited work has been done quantifying the incidence of subsequent complications and their healthcare economic impact. The purpose of this study was to quantify the incidence and healthcare resource utilization (HCRU) for major complications that can arise from ICH.

METHODS

The IBM MarketScan Research databases were used to retrospectively identify patients with ICH from 2010 to 2015. Complications examined included cerebral edema, hydrocephalus, venous thromboembolic events (VTEs), pneumonia, urinary tract infections (UTIs), and seizures. For each complication, inpatient mortality and HCRU were assessed.

RESULTS

Of 25,322 adult patients included, 10,619 (42%) developed complications during the initial admission of ICH: 22% had cerebral edema, 11% hydrocephalus, 10% pneumonia, 6% UTIs, 5% seizures, and 5% VTEs. The inpatient mortality rates at 7 and 30 days for each complication of ICH ranked from highest to lowest were hydrocephalus (24% and 32%), cerebral edema (15% and 20%), pneumonia (8% and 18%), seizure (7% and 13%), VTE (4% and 11%), and UTI (4% and 8%). Hydrocephalus had the highest total cost (median $92,776, IQR $39,308–$180,716) at 7 days post–ICH diagnosis and the highest cumulative total cost (median $170,839, IQR $91,462–$330,673) at 1 year post–ICH diagnosis.

CONCLUSIONS

This study characterizes one of the largest cohorts of patients with nontraumatic ICH in the US. More than 42% of the patients with ICH developed complications during initial admission, which resulted in high inpatient mortality and considerable HCRU.

ABBREVIATIONS ECI = Elixhauser Comorbidity Index; HCRU = healthcare resource utilization; ICH = intracerebral hemorrhage; LOS = length of stay; RCT = randomized controlled trial; UTI = urinary tract infection; VTE = venous thromboembolic event.

Supplementary Materials

    • eTables 1-7 (PDF 579 KB)

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Contributor Notes

Correspondence Shivanand P. Lad: Duke University Medical Center, Durham, NC. nandan.lad@duke.edu.

INCLUDE WHEN CITING Published online January 22, 2021; DOI: 10.3171/2020.8.JNS201839.

Disclosures Dr. Lad is a consultant for Abbott Laboratories, Boston Scientific, Higgs Boson Health, Medtronic, Minnetronix, Nevro, and Presidio Medical. Dr. Verbick has direct stock ownership in Minnetronix. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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