Abstract
Background and PurposeWith the drastically aging population in the U.S., non-traumatic subacute and chronic subdural hematomas (sacSDH) are projected to represent the most common neurosurgical diagnosis requiring treatment within the next two decades. The Premier Healthcare Database (PHD) is an all-payer database comprising about 20% of U.S. inpatient discharges from over 800 U.S. hospitals since 2012.ObjectiveTo portray current mortality rates, complication rates, and length of stay with inpatient sacSDH care.MethodsThe PHD (Premier Inc., Charlotte, NC) was queried for encounters between 10/2016 and 12/2020 with the ICD-10 diagnoses I62.00, I62.02, I62.03 to cover non-traumatic as well as non-acute subdural hematoma as the principal diagnosis among patients age ≥ 40 years. Medical and surgical treatment was compared. In-hospital mortality is defined as an inpatient who is not discharged. Complications represent medical conditions not present on admission that affect mortality, length of stay, and costs within the database. Length of stay represents time spent as an inpatient. Distributions were estimated by yearly strata and compared using Student’s t-tests.ResultsThe query identified up to 14,136 inpatient encounters. Between 10/2016 and 12/2020, in-hospital mortality rates averaged 10.9% in the medical group (MG) and 3.6% in the surgical group (SG) (p<0.001). Complication rates averaged between 8.9% in the MG and 19.9% in the SG (p<0.001). LOS averaged 3.0 days in the MG and 5.7 days in the SG (p<0.001). Total costs averaged $ 10,233 in the MG and $ 26,658 in the SG. Among all encounters, 4570/14,136 (32.3%) were ≥ 80 years. Here, mortality and complication rates in the MG (12.5% and 9.5%, respectively) and the SG (4.6% and 23.5%) were higher than in patients aged 40 - 59 and 60 - 79.ConclusionThe standardized outcomes presented represent an objective benchmark of contemporary sacSDH treatment outcomes in the U.S. It remains to be determined whether new treatment strategies such as middle meningeal embolization yield significant benefits to flatten the impending healthcare burden of sacSDH.Disclosures P. Hendrix: None. I. Melamed: None. O. Goren: None. G. Weiner: None. C. Schirmer: None.