Length of Stay, Cost, and Outcomes related to Traumatic Subdural Hematoma in inpatient setting in the United States

ABSTRACT

Objective

In the US, the prevalence of traumatic subdural hematoma (TSDH) continues to increase. Using a nationally representative sample of discharge records of patients with TSDH, the study objectives were to estimate trend in number of TSDH cases, surgical management, inpatient cost, length of stay (LOS), mortality rate, and complication rate; and to identify the association of sociodemographic, clinical and hospital characteristics with complications and mortality.

Method

We identified patients with a primary diagnosis of TSDH from the National Inpatient Sample (NIS) database from 2010 to 2017. Quarterly and monthly trends were estimated using interrupted time series design. Multivariate logistic regressions measured association between various factors and inpatient death and complications.

Results

Number of cases, mean LOS, rate of complication increased. Proportion of patients undergoing surgery, mean inpatient cost, inpatient mortality decreased. Mean inpatient cost was $23,182.40 and LOS was 6.41 days. Odds of inpatient death and complications increased with injury severity score and comorbid conditions requiring use of anticoagulants. Odds of inpatient death were highest among those ≥85 years old and in south and northeast region.

Conclusion

Given the increase in prevalence of TSDH in USA, additional resources should be allocated toward improving patient outcomes and lowering healthcare costs.

KEYWORDS:

• National inpatient sample (NIS)
• traumatic subdural hematoma
• inpatient cost
• length of stay
• neurosurgery complications
• trend analysis

Disclosure statement

Eshani J Choksi reports no conflicts of interest. Dr. Mukherjee has received a grant from Organic Remedies and Harvey L Neiman Health Policy Institute (sub grant from Emory University) in the past year. These grants have no relation with the material discussed in this manuscript. Dr. Kamal reports receiving honorarium from Pharmacy Times Continuing Education outside the submitted work. This has no relation or conflict with the materials discussed in this manuscript. Dr. Yocom reports no conflicts of interest to report. Dr. Salazar reports no conflicts of interest to report.

Additional information

Funding

This study was funded by the Division of Research of the Philadelphia College of Osteopathic Medicine to purchase the dataset;Division of Research, Philadelphia College of Osteopathic Medicine [KM2020];