Abstract TP34: Outcomes and Trends of Subarachnoid Hemorrhage During the COVID-19 Pandemic

Background: Hemorrhagic cerebrovascular manifestations are known to be associated with COVID-19. Our study aims to describe the trends and outcomes of patients with Subarachnoid Hemorrhage (SAH) using a Nationwide Inpatient Sample (NIS) database.

Methods: We examined the 2016-2020 NIS database, focusing on patients aged 18 years and older with a primary SAH discharge diagnosis. Comparative outcome analyses between pre-COVID (2016-2019) and COVID year (2020) were performed. NIS-Subarachnoid Hemorrhage Severity Score (NIS-SSS) was used as a surrogate marker for the modified Rankin Scale.

Results: Our analysis of 119,005 patients with subarachnoid hemorrhage (SAH) unveiled a median age of 59.6 years with 72,650 (61.0%) being female. Comparisons across age (p=0.867), gender (p=0.08), and length of stay (p=0.130) showed no significant differences between groups. Median NIS-SSS score was 3.6, revealing an increase from pre-COVID 3.3 to COVID 5.6 (p=0.0006). Adjusted analyses exhibited similar inpatient mortality (COVID vs. pre-COVID: OR 0.98, 95% CI 0.89-1.08, p=0.71). However, advancing age (OR 1.01, p<0.001), NIS severity score >10 points (OR 11.11, p<0.001), CHF (OR 1.47, p<0.001), coagulopathy (OR 1.47,p<0.001), cocaine use (OR 1.46, p=0.001), and weekend discharges (OR 1.09, p=0.04) were linked to increased mortality odds. In 2020, non-COVID SAH rates remained stable (9.2% - 9.4%, Ptrend=0.42), while COVID-associated SAH surged (1.2% - 21%, Ptrend=0.023).

Conclusion: Our study finds no disparity in outcomes for patients hospitalized with aneurysmal subarachnoid hemorrhage (aSAH) during the COVID-19 pandemic when contrasted with the preceding years. However, a substantial rise in SAH admissions among COVID-19 patients is evident. Exploring the physiological reasons behind this observed trend could be a crucial avenue for further investigation.