====== Aneurysmal subarachnoid hemorrhage length of stay ======


The clinical course of [[subarachnoid hemorrhage]] generates high [[health economics]] [[expenses]]. 

Ridwan et al. highlighted possible [[cost driver]]s for in-[[hospital]] [[care]] [[expenses]] for the first year. Furthermore, results are compared with [[ischemic stroke treatment]].

One hundred and one patients with [[aneurysmal subarachnoid hemorrhage]] treated in the [[University Hospital Bonn]], from 2007 through 2009 were included. The Hunt and Hess (HH) scale, World Federation of Neurosurgical Societies (WFNS) scale, Fisher Scale, and further outcome-relevant data were recorded. Expenses were calculated using the German fixed case rate classification system consisting of Diagnosis-Related Groups (DRG) and the Operation and Procedure catalog (OPS). Overall acute [[length of stay]] (LOS) and LOS on the [[intensive care unit]] (ICU) were separately evaluated. Expenses were compared with formerly published first-year costs of ischemic stroke.

Fifty-four percent of the patients (median age 52 years, 69% females) received coiling and 46% clipping. Acute in-hospital treatment accounted for 82% of total in-hospital expenses, while consequential in-hospital treatment accounted only for 18%. Altogether, the total first-year in-hospital expenses for all patients were as high as €2,650,002, resulting in average SAH in-hospital treatment expenses of €26,238 per patient for the first year. Poor clinical condition on admission and longer stay in ICU are the main cost-driving factors. The impact of the aneurysm treatment method is debatable. Only a poor HH grade and longer ICU stay are independent cost-driving factors. SAH treatment expenses are far higher than treatment costs for ischemic stroke in the literature (€6,731 for first-year inpatient and €3,287 for outpatient treatment).

Clinical condition and [[length of stay]] (LOS) determine in-[[hospital expenses]] after [[subarachnoid hemorrhage]]. [[Aneurysmal subarachnoid hemorrhage]] prevalently results in a relevant economic impact on the [[health system]] exceeding formerly published treatment expenses for [[ischemic stroke]]
((Ridwan S, Urbach H, Greschus S, Hagen JV, Esche J, Boström A. Health Economic Aspects of Aneurysmal Subarachnoid Hemorrhage: Factors Determining First Year In-Hospital Treatment Expenses. J Neurol Surg A Cent Eur Neurosurg. 2021 Jan 24. doi: 10.1055/s-0040-1720982. Epub ahead of print. PMID: 33486751.)).