Cost of hospitalization for aneurysmal subarachnoid hemorrhage in the United States

Modi, Sumul; Shah, Kavit; Schultz, Lonni; Tahir, Rizwan; Affan, Muhammad; Varelas, Panayiotis N.

doi:10.1016/j.clineuro.2019.05.018

Cited by 23 publications

(16 citation statements)

References 35 publications

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“…As one might expect, SAH has a high case fatality rate (32-67%); of those that survive the initial bleed, 30-50% will suffer long-term disability as a result of serious brain injury (3)(4)(5). In terms of productive life years lost, SAH closely rivals more common forms of stroke due to its early age of onset (1,6): thus, SAH incurs a disproportionately heavy cost (7), despite being a relatively rare form of stroke (∼10 in 100,000 persons per year) (8)(9)(10). The interventions to halt ruptured aneurysm bleeding and prevent subsequent re-bleeds are frequently successful: thus, if the patient survives the initial bleeding event, which depends on the severity of bleeding and how quickly emergency medical attention is initiated, most of the treatable mortality and morbidity in SAH occurs during neurointensive care.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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Subarachnoid hemorrhage (SAH) is a devastating stroke subtype with a high rate of mortality and morbidity. The poor clinical outcome can be attributed to the biphasic course of the disease: even if the patient survives the initial bleeding emergency, delayed cerebral ischemia (DCI) frequently follows within 2 weeks time and levies additional serious brain injury. Current therapeutic interventions do not specifically target the microvascular dysfunction underlying the ischemic event and as a consequence, provide only modest improvement in clinical outcome. SAH perturbs an extensive number of microvascular processes, including the “automated” control of cerebral perfusion, termed “cerebral autoregulation.” Recent evidence suggests that disrupted cerebral autoregulation is an important aspect of SAH-induced brain injury. This review presents the key clinical aspects of cerebral autoregulation and its disruption in SAH: it provides a mechanistic overview of cerebral autoregulation, describes current clinical methods for measuring autoregulation in SAH patients and reviews current and emerging therapeutic options for SAH patients. Recent advancements should fuel optimism that microvascular dysfunction and cerebral autoregulation can be rectified in SAH patients.

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Section: Introductionmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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“…Subarachnoid haemorrhage (SAH) is caused by rupture of intracranial aneurysms [1,2]. Approximately 5-15% of the stroke patients have ruptured intracranial aneurysms [3,4].…”

Section: Subarachnoid Haemorrhagementioning

confidence: 99%

“…Aneurysmal SAH leads to a prolonged hospital stay [1]. Therefore, aneurysmal subarachnoid haemorrhage results in a significant financial burden in the USA [1].…”

Section: Subarachnoid Haemorrhagementioning

confidence: 99%

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Serum Homocysteine and Intracranial Aneurysms

Tai¹,

Toh²,

Hussain³

et al. 2020

New Insight Into Cerebrovascular Diseases - An Updated Comprehensive Review

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Subarachnoid haemorrhage (SAH) occurs as a result of rupture of intracranial aneurysms. SAH causes significant morbidity and mortality. In addition, SAH leads to significant financial burden. In this chapter, we will look into the association between raised serum homocysteine and intracranial aneurysms. In a study on the Han Chinese patients with intracranial aneurysm who were admitted to the hospital, the mean serum total homocysteine level in the patient group with intracranial aneurysm was significantly higher than those in the control group. In the same study, the patients with raised serum homocysteine had 2.196 higher risk of developing intracranial aneurysms. Ren et al. proposed that homocysteine should be seen as an indicator of the risk of intracranial aneurysm and not a direct cause of intracranial aneurysm. In another study, homocysteine increases the development of intracranial aneurysms in rats. Endothelial damage is an early change in the walls of intracranial aneurysms. Polymorphisms of the genes coding for the various components of the vessel walls may be associated with the formation of intracranial aneurysms. In a previous animal study, the size of intracranial aneurysms is significantly smaller in the mice with inducible nitric oxide synthase (iNOS) compared with the mice without iNOS.

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“…Nevertheless, it is undeniable that the mortality and prognosis of the disease are still disappointing as, rst, aSAH usually affects relatively young people, leading to severe disability and loss of working ability ahead of time, so the medical burden on families and society can be directly reduced with a good outcome (mRS=0-3). But several studies have shown that aSAH is still a major nancial burden on health care systems in many countries [13][14][15] . Second, early surgical interventions (Craniotomy Clipping and Endovascular Embolization) of ruptured aneurysms can effectively reduce the incidence of rebleeding and mortality of patients.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness Comparisons of Drug Therapies for Postoperative Aneurysmal Subarachnoid Hemorrhage Patients: Network Meta‑analysis and systematic review

Huang

Zhang

et al. 2021

Preprint

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Objective: To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis.Methods: Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies.Results: From the 493 of initial citation screening, forty-four RCTs (n=10626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR=3.35,95%CI=1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA=87.29%, 95%CrI 0.07-0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR=1.61, 95%CI 1.01,2.57) and cilostazol (OR=3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients. Conclusions: Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.

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Cost of hospitalization for aneurysmal subarachnoid hemorrhage in the United States

Cited by 23 publications

References 35 publications

Cerebral Autoregulation in Subarachnoid Hemorrhage

Cerebral Autoregulation in Subarachnoid Hemorrhage

Serum Homocysteine and Intracranial Aneurysms

Effectiveness Comparisons of Drug Therapies for Postoperative Aneurysmal Subarachnoid Hemorrhage Patients: Network Meta‑analysis and systematic review

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