Functional Recovery and Risk of Readmission in Low-Grade aSAH Patients
Patients with aneurysmal subarachnoid hemorrhage (aSAH) are traditionally hospitalized for 14-21 days due to the high risk of cerebral vasospasm. The guidelines for low-grade SAH are less concrete and such patients are often discharged sooner given their lower risk of neurological complications. There is however a paucity of evidence regarding their risk of complications after discharge and their risk of readmission.
This is retrospective study of 424 patients with low-grade aSAH admitted to Thomas Jefferson University Hospital from 2008-2015. We collected data of patient comorbidities, Hunt-Hess (H-H) grade, length of stay (LOS), and complications and performed a logistic regression to determine the cause
Out of 424 patients, 50 (11.8%) developed neurological complications after the first week that warranted prolonged ICU admission (mean 16.3±6.5 days). Of the remaining 374 (88.2%) patients without neurological complications, 83 (22.2%) developed late medical complications with mean LOS of 15.1 ± 7.6 days, while those without medical complications stayed 11.8 ± 6.2 days (p=0.001). Among the patients with late medical complications, 55 (66.3%) did not have any hospital-associated complications in the first week. Smoking (p=0.062), history of cardiac disease (p=0.043), H-H grade 3 (p=0.012), IVH (p=0.012), external ventricular drain (EVD) placement (p=0.002) and DVT/UTI/pneumonia in the first week (p=0.001) were individually associated with late medical complications. Multinomial logistic regression showed early DVT/UTI/ pneumonia (p=0.026) and increasing H-H grade (p=0.057) to be the most important risk factors for late medical complications.
While an extended ICU admission offers the benefit of closer monitoring, many patients develop hospital-associated complications, despite being low risk for neurological complications. We report in detail the characteristics of low-grade aSAH patients who would benefit from early discharge in an effort to prevent hospitalassociated complications.