Outcome and Cost in the Management of Patients in Poor Neurological Grade following Aneurysmal Subarachnoid Haemorrhage

Introduction: Patients in poor neurological grade following aneurysmal subarachnoid haemorrhage (SAH) have significant morbidity and mortality with a favourable outcome rate of 20-40%. The management costs are significant, with many patients requiring prolonged inpatient treatment and complex interventions. The aim of this study was to audit the outcome and associated cost in the management of patients in poor neurological grade following SAH within the context of the Irish healthcare system.

Methods: Retrospective review of the management and outcome of patients in poor neurological grade following SAH between 2018 and 2022. Eligible patients were identified from the hospital coding database - patients with a diagnosis of aneurysmal SAH who presented in poor neurological grade were included. Chart and radiological reviews were performed to collect relevant data. Aneurysm treatment cost, neurocritical care cost and length of stay cost were calculated.

Results: Seventy-two patients were included, of whom 75% were female. The median age was 61.5 years (range 17-90, SD 13.28). 62.5% were WFNS grade 5. 19.4% had posterior circulation aneurysms. 59.7% of patients underwent aneurysm treatment of whom 82.9% were treated within 48 hours of ictus. Median length of stay was 14 days (range 1-308, SD 43). The mean cost was €22,328.61 per patient (range 0-€154,690, SD €24,660.99). 34.5% of patients were independent at 6 months follow-up (GOS 4 or 5); good neurological outcome was positively correlated with GCS at presentation (f = .636, p < .001) and negatively correlated with underlying hypertension (f = -.449, p = .008).

Conclusion : The outcome of patients in poor neurological grade following SAH remains poor despite earlier aneurysm treatment, advances in endovascular techniques, and improved neurocritical care intervention. The management of these patients is associated with a significant cost. Our study did not consider the costs relating to rehabilitation and loss of working life years. This data is of benefit with respect to guiding adequate allocation of healthcare resources in the future.