{
  "abstract": "Objective To evaluate whether segregation in where patients receive aneurysmal subarachnoid hemorrhage (aSAH) treatment is associated with in-hospital outcomes and end-of-life care.Methods Using the 2018-2022 National Inpatient Sample, we identified adults hospitalized with a principal diagnosis of nontraumatic aSAH due to intracranial aneurysm who underwent clipping, endovascular coiling, or flow-diverter-based treatment. Segregation was quantified annually within U.S. Census divisions using the Duncan dissimilarity (D) index across treating hospitals based on the distribution of Black versus White treated aSAH admissions; hospitals were categorized into low (T1), moderate (T2), and high (T3) segregation tertiles. Outcomes included in-hospital mortality, unfavorable discharge, palliative care, do-not-resuscitate (DNR) status, and life-sustaining procedures. Palliative care and DNR were identified using ICD-10-CM codes Z51.5 and Z66. Associations were tested with survey-weighted multivariable logistic regression adjusting for patient factors, hospital characteristics, illness severity, and era.Results The cohort comprised 99,430 weighted treated aSAH hospitalizations, distributed across T1 35.1%, T2 30.5%, and T3 34.4%. Mean age was 61.3 years and 56.3% were women. Black patients were more concentrated in higher-segregation facilities (15.6% in T1 vs 27.5% in T3, p<0.001). Over time, the share treated in the highest tertile declined from 38.5% (2018-2019) to 30.7% (2021-2022) (p<0.001), while T1 increased to 40.5%. Unadjusted mortality was similar across tertiles (18.2% T1, 18.6% T2, 19.3% T3, p=0.303), as was unfavorable discharge (~56%, p=0.630). Palliative care (15.6-16.2%, p=0.538) and DNR documentation (20.0-20.7%, p=0.547) varied little, whereas life-sustaining procedures differed modestly (31.1-34.9%, p<0.001). After adjustment, segregation tertile was not independently associated with mortality (T1 vs T3 aOR 1.18, 95% CI 0.68-2.05; T2 vs T3 aOR 1.07, 0.65-1.77) and was not associated with palliative care, DNR, or life-sustaining procedures. Illness severity remained the dominant predictor of mortality. Independent of segregation, non-Black patients had higher odds of palliative care (aOR 2.15) and DNR (aOR 1.86), while life-sustaining procedures were less frequent in non-Black patients (aOR 0.74).Conclusions Segregation strongly influenced where Black patients received treated aSAH care, but did not explain differences in mortality or end-of-life care after adjustment. Racial differences in care intensity and end-of-life decision-making persisted beyond facility segregation, underscoring the need for targeted evaluation of decision-making processes and communication around goals of care.Disclosures K. Gupta: None. M. Karsy: None. D. Altschul: None.Abstract E-194 Table 1",
  "authors": [
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "K Gupta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan, Lansing, MI"
      ],
      "name": "M Karsy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Florida, Gainesville, FL"
      ],
      "name": "B Lucke-Wold"
    },
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-194 Facility segregation, race, and care intensity after treated aneurysmal subarachnoid hemorrhage in the United States, 2018-2022",
  "uid": "29ad23ec-4f35-50b2-a4d6-5548961c6ce4"
}