In US adults hospitalized with aneurysmal subarachnoid hemorrhage, 42.4% had ≥1 medical complication; clipping was associated with 24% higher DVT risk and 13% greater poor outcome prevalence compared to coiling.
Cross-Sectional (n=163,349)
Yes
While infectious complications after aneurysmal subarachnoid hemorrhage have declined over the last decade, there has been a significant and concerning increase in the prevalence of acute renal failure and deep venous thrombosis, all of which are associated with poor clinical outcomes.
Effect estimate: PRR 1.24 for DVT with clipping vs coiling; PRR 0.66 for GIB with clipping vs coiling; PRR 1.13 for poor outcome with clipping vs coiling (95% CI 95% CI: 1.13–1.37 for DVT; 0.54–0.80 for GIB; 1.10–1.15 for poor outcome)
p-value: p=<0.001 for all mentioned
Abstract Objectives To analyze trends in the prevalence of medical complications in aneurysmal subarachnoid hemorrhage (aSAH) hospitalizations in the USA over the last decade. Methods A serial cross-sectional study was performed using the 2006–2022 National Inpatient Sample. Adult (≥ 18 years) primary aSAH hospitalizations with and without complications were identified using International Classification of Diseases codes. Negative binomial regression models were used to evaluate the associations between complications, individualized hospitalization characteristics, and hospital outcomes. Results Of 163,349 aSAH hospitalizations over the study period, 68.2% were female. The mean age was 55.6 years, and this increased over time ( p -trend < 0.001). The mean National Inpatient Sample Subarachnoid Severity Score was 5.5 standard error (SE) 0.06 and this also increased over time. Overall, 42.4% of hospitalizations had ≥ 1 medical complication. Urinary tract infections (UTI) (19.4%), pneumonia (15.4%), and sepsis (8.0%) were the most prevalent complications, while acute renal failure (ARF) (7.8%) was the most frequent noninfectious complication. The age- and sex-standardized prevalence of any medical complication remained stable over this study period, but there was marked heterogeneity in prevalence trends by complication type. ARF prevalence increased by nearly 300% prevalence rate ratio (PRR): 1.04 per year, 95% confidence interval (CI): 1.02–1.04, p < 0.001 and deep venous thrombosis (DVT) prevalence increased by more than 200% (PRR:1.03, 95% CI: 1.01–1.04, p < 0.001) per year, while UTI and sepsis prevalence declined over this time (all p -trend < 0.001). Pneumonia prevalence declined in male only ( p -trend < 0.05). Clipping was associated with higher DVT risk (PRR 1.24, 95% CI: 1.13–1.37) but lower gastrointestinal bleeding risk (PRR 1.14, 95% CI: 0.95–1.38) compared with coiling. All complications were significantly linked to poor outcomes (e.g., pneumonia: PRR 1.23, 95% CI: 1.20–1.30). Conclusions The prevalence of infectious complications in aSAH has declined over the last decade, but this has been counterbalanced by a troubling increase in ARF and DVT prevalence. Given the strong association of all complications with poor outcomes, future studies focused on mitigating the prevalence of complications are needed to help improve aSAH outcomes.
Sabra et al. (2026) conducted a cross-sectional in Adult patients (≥18 years) hospitalized with aneurysmal subarachnoid hemorrhage (aSAH) undergoing aneurysm clipping or coiling in the USA (n=163,349). Aneurysmal clipping vs. coiling vs. Coiling was evaluated on Prevalence of medical complications during aSAH hospitalization and association with poor outcomes (composite NIS Subarachnoid Hemorrhage Outcome Measure) (PRR 1.24 for DVT with clipping vs coiling; PRR 0.66 for GIB with clipping vs coiling; PRR 1.13 for poor outcome with clipping vs coiling, 95% CI 95% CI: 1.13–1.37 for DVT; 0.54–0.80 for GIB; 1.10–1.15 for poor outcome, p=<0.001 for all mentioned). In US adults hospitalized with aneurysmal subarachnoid hemorrhage, 42.4% had ≥1 medical complication; clipping was associated with 24% higher DVT risk and 13% greater poor outcome prevalence compared to coiling.