Abstract:
OBJECTIVE:To investigate potential health care discrepancies in patients with ruptured cerebral aneurysms undergoing microsurgical intervention. METHODS:We retrospectively reviewed patients with ruptured intracranial aneurysms treated at our tertiary referral university hospital (UH) and safety net county hospital (CH) from 2010 to 2015. We identified 73 UH patients and 58 CH patients. RESULTS:UH patients had shorter time duration between rupture and intervention (P < 0.001) and higher rates of intubation on admission (P = 0.01). Verapamil was more frequently used for clinical vasospasm in UH patients, at 0.13 (95% confidence interval [CI], 0.09-0.18) treatments per patient per day versus 0.077 (95% CI, 0.047-0.12) treatments per patient per day in CH patients, though there was no difference in delayed cerebral ischemia (P = 0.15). The majority of the CH cohort was uninsured (26.3%; UH 0%) or had Medicaid (59.7%; UH 35.2%) (P < 0.001). The UH had more dispositions to home or rehabilitation centers than the CH (82% vs. 67.3%; P = 0.04). After adjusting for disease severity, hospital stay, and insurance status, CH patients were 3.73 (95% CI, 1.25-12.14) times more likely to be discharged with a poor modified Rankin Scale score and 3.08 (95% CI, 1.04-9.61) times more likely to be discharged with a poor Glasgow Outcome Scale score compared with UH patients (P = 0.02 and P = 0.04, respectively). CONCLUSIONS:Limited resource availability in a safety net hospital system could be a major driving force behind the health care discrepancy identified in our ruptured cerebral aneurysm population. Reallocation of resources to supplement advanced inpatient acute care technologies and, more importantly, post-acute care environments can narrow the outcomes gap.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Strickland BA,Mert M,Ravina K,Chartrain A,Rennert RC,Bakhsheshian J,Shahrestani S,Jackanich A,Amar A,Mack W,Russin JJ,Giannotta SLdoi
10.1016/j.wneu.2020.03.087subject
Has Abstractpub_date
2020-06-01 00:00:00pages
e787-e794eissn
1878-8750issn
1878-8769pii
S1878-8750(20)30558-1journal_volume
138pub_type
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journal_title:World neurosurgery
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,meta分析,评审
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