Background: The estimates of recurrent intracranial hemorrhage in post hospitalization period among patients treated for ruptured intracranial aneurysms are not available outside clinical trials.
Objective: To determine the rates of recurrent intracranial hemorrhage related hospitalization within 1 year post hospitalization for treatment of ruptured intracranial aneurysm in a nationwide cohort of patients admitted for subarachnoid hemorrhage (SAH).
Methods: We identified all readmissions related to new SAH or intracerebral hemorrhage in the nationally representative data for all patients hospitalized for SAH using the Nationwide Readmissions Database (NRD) 2013 who had undergone endovascular or surgical treatment.. Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent intracranial hemorrhage for patients in treatment cohorts after adjusting for potential confounders. The 1-year survival was estimated for both treatment groups by using Kaplan-Meier survival method.
Results: A total of 5,844 patients with SAH were treated with either endovascular (n = 2,843, 48.6%) or surgical treatment (n = 3000, 51.4%).The rate of all-cause in-hospital mortality (10.2% vs 12.1%, P = 0.1895) was similar among patients treated with surgical or endovascular treatment. The estimated 1-year recurrent intracranial hemorrhage survival was 99.5% and 97.4% in patients who underwent surgical and endovascular treatments, respectively (p= <.0001). After adjusting for age, and All Patient Refined DRGs (APDRG) severity score, the RRs of recurrent any intracranial hemorrhage was higher with endovascular treatment (RR, 6.0; 95% confidence interval (CI), 2.3 -15.7 p= 0.0002). The rates of SAH (RR, 6.1; 95% CI, 2.1 -17.9 p= <.0001) was significantly higher and a trend was observed for higher rate ofintracerebral hemorrhage (RR, 6.2; 95% confidence interval, 0.7 -52.5 p=0.0940) among patients treated with endovascular modality. .
Conclusion: Although the rates of recurrent intracranial hemorrhage related hospitalization were low among patients with ruptured intracranial aneurysms, there was a higher rate among patients treated with endovascular treatment.