E-283 'Time Is Brain': impact of admission time on subarachnoid hemorrhage patient outcomes, a 7-year study. (23rd July 2022)

• Record Type: Journal Article
• Authors: Mahajan, U; Zhou, X; Bates, A; Desai, A; Butke, J; Shammassian, B; Duan, Y; Burant, C; Hoffer, S
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A232
• Page End: A233
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.394
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: In patients with aneurysmal subarachnoid hemorrhage (aSAH), emergent aneurysm securement is performed to minimize complications and optimize outcomes. It is not well characterized how time of admission impacts time to intervention or outcomes. Methods: We conducted a retrospective review of adult aSAH cases between 2013 and 2019 at a single large tertiary medical center. Data extracted included patient demographics, admission time, insurance, aneurysm location, disease severity, time to aneurysm treatment (defined as time in minutes from admission to operating room time-out), hospital length of stay, complications, and final discharge disposition. Results: 880 patient records were reviewed, and 205 patients met inclusion criteria. 48 patients were admitted between 12AM-8AM ('Shift 1'), 77 patients were admitted between 8AM-4PM ('Shift 2'), and 86 patients were admitted between 4PM-12AM ('Shift 3'). There was no difference in length of stay between the three groups (p=0.959, mean length of stay: 18.61 days). Black patients comprised a greater proportion of patient admitted in Shift 1 (42.2%) compared to Shifts 2 (19.7%) or 3 (23.8%), (p=0.019). There was a significant difference in median time to aneurysm treatment (652 minutes in Shift 1, 1248 minutes in Shift 2, 972 minutes in Shift 3; p<0.001). There was no difference between the three shifts in percentage coiled versus clipped (p=0.567) or discharge disposition (p=0.404; overall 68% favorable disposition and 32% poor disposition). There was no difference in rebleed (p=0.242), vasospasm (p=0.369), or additional intervention (p=0.667) between the admission shifts. Time to aneurysm securement under versus over 1440 minutes (1 day) was not associated with discharge disposition (p=0.342). However, time to aneurysm securement greater than 2880 minutes (2 days) was associated with poor discharge disposition (p=0.030). Conclusion: Admission time for aSAH patients is associated with time to aneurysm securement; patients admitted in the night or early morning receive aneurysm securement faster, but there is no difference in outcomes. Aneurysm securement over 2 days after admission is associated with poor disposition. Disclosures: U. Mahajan: None. X. Zhou: None. A. Bates: None. A. Desai: None. J. Butke: None. B. Shammassian: None. Y. Duan: None. C. Burant: None. S. Hoffer: None.