{
  "abstract": "Objective Aneurysmal subarachnoid hemorrhage (aSAH) remains associated with high morbidity and mortality despite advances in microsurgical and endovascular treatment. While prior studies have identified demographic, socioeconomic, and hospital-level predictors of outcome, whether these factors exert differential effects across treatment modalities remains incompletely understood. We evaluated national trends and independent predictors of in-hospital morbidity and mortality following aSAH, stratified by treatment modality.Methods We conducted a retrospective cohort study using the National Inpatient Sample (2000-2020), including adults with ruptured intracranial aneurysms treated with either surgical clipping or endovascular therapy. Patients receiving both modalities were excluded. Outcomes included in-hospital mortality, extended length of stay (eLOS; top quartile), non-home discharge, and post-procedural complications. Multivariable logistic regression models were constructed separately for each modality, adjusting for demographics, socioeconomic variables, hospital characteristics, and severity of illness using the All Patient Refined Diagnosis-Related Groups (APR-DRG) system.Results A total of 203,736 patients met inclusion criteria. Endovascular treatment increased from <10% of cases in 2000 to >90% by 2020. Unadjusted in-hospital mortality was similar between clipping (12.1%) and endovascular therapy (14.0%). Female sex was associated with fewer complications in both cohorts and lower mortality after endovascular treatment, but with increased likelihood of eLOS across modalities. African American race was associated with higher complication rates and non-home discharge after endovascular treatment, yet lower mortality following clipping. Insurance status demonstrated modality-specific effects: Medicare insurance was associated with increased mortality and complications in the clipping cohort but not the endovascular cohort, while self-pay status was associated with increased mortality in both. Treatment at urban non-teaching hospitals was independently associated with higher complication rates and non-home discharge, with a greater effect size in the clipping cohort.Conclusions Although overall mortality after aSAH was similar between clipping and endovascular therapy, the predictors of morbidity and mortality differed meaningfully by treatment modality. These findings underscore the importance of considering demographic, socioeconomic, and hospital-level context alongside clinical severity when evaluating outcomes after aSAH and highlight persistent structural inequities influencing care delivery.Disclosures M. Salem: None. M. Ohene-Adjei: None. J. Seinfeld: None.Abstract E-242 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "M Salem"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical College, Albany, NY"
      ],
      "name": "A Gajjar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO"
      ],
      "name": "R Moseley"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorady, Aurora, CO"
      ],
      "name": "A Helal"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "M Ohene-Adjei"
    },
    {
      "affiliations": [
        "Mayo Clinic, Rochester, MN"
      ],
      "name": "A Ghaith"
    },
    {
      "affiliations": [
        "Albany, NY"
      ],
      "name": "A Paul"
    },
    {
      "affiliations": [
        "Neurosurgery, Baylor College of Medicine, Houston, TX"
      ],
      "name": "V Srinivasan"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Centennial, CO"
      ],
      "name": "D Case"
    },
    {
      "affiliations": [
        "Neurosurgery / Neuroradiology, Penn Medicine, Gladwyne, Germany"
      ],
      "name": "J Burkhardt"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Michigan, Ann Arbor, MI",
        "University of Colorado, Aurora, CO"
      ],
      "name": "C Roark"
    },
    {
      "affiliations": [
        "University of Colorado, Aurora, CO"
      ],
      "name": "J Seinfeld"
    }
  ],
  "title": "E-242 Predictors of morbidity and in-hospital mortality in aneurysmal subarachnoid hemorrhage: insights from two decades of national data",
  "uid": "656149aa-440d-5d6d-92ff-82a9dca47eda"
}