MORTALITY-RATES, HOSPITAL LENGTH OF STAY, AND THE COST OF TREATING SUBARACHNOID HEMORRHAGE IN OLDER PATIENTS - INSTITUTIONAL AND GEOGRAPHICAL DIFFERENCES

The risk of disability and death and the cost of medical care are part icularly high for patients with aneurysmal subarachnoid hemorrhage (SA H) who are 65 years of age or older. A retrospective analysis of 47,40 8 Medicare patients treated over an 8-year period was performed to det ermine whether a relationship exists between the mortality rate and su rgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH i n California and New York state were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and wh o were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging betw een one and five craniotomies annually the mortality rate was 18.4%; a nd in those averaging less than one such operation per year the rate w as 20.5% (trend p = 0.01). There was no difference in the mortality ra te for patients in California versus the rate for those in New York. S urgically and medically treated patients, respectively, left the hospi tal an average of 6.7 and 5.1 days sooner in California than in New Yo rk. The unadjusted average reimbursement from Medicare to hospitals fo r surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated pati ents in the two states. The mortality rate in older patients who are t reated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age o r older at a given institution. Hospital stays for patients with SAH a re significantly shorter in California than in New York.