HOSPITAL RESOURCE UTILIZATION IN THE TREATMENT OF CEREBRAL ANEURYSMS

The authors reviewed clinical and financial data for all patients trea ted for nontraumatic subarachnoid hemorrhage (SAH) and unruptured cere bral aneurysms at their institution between June 1993 and December 199 4. This study sought to identify specific areas of high resource utili zation that may be amenable to reduction of expenditures without compr omising quality of care. Detailed hospital financial data were correla ted with clinical grade and course. Areas of high resource use were id entified based on patient charges and category-specific loaded hospita l cost. Patients were divided into four groups: Group 1. surgically tr eated unruptured aneurysms (28 patients); Group 2, acute SAH (42 patie nts); Group 3, SAH with vasospasm (32 patients); and Group 4, SAH with negative angiogram (10 patients). Total cost per patient (mean +/- st andard deviation in thousands of U.S. dollars) was highest for Group 3 (38.4 +/- 21.31 vs. Group 1, 12.7 +/- 8.8; Group 2, 22.6 +/- 20.9; an d Group 4 25.0 +/- 33.5) and correlated with hospital length of stay, Hunt and Hess grade, and Fisher grade. Areas of highest hospital cost were not always reflected in patient charges. The three areas of highe st cost accounted for 48.5% of the total cost and were: 1) intensive c are unit ICU) room (Group 1, 2.5 +/- 3.5; Group 2, 7.0 +/- 9.2; Group 3, 11.0 +/- 7.8; and Group 4, 7.9 +/- 14.1); 2) arteriography (Group 1 , 1.7 +/- 1.2; Group 2, 2.1 +/- 1.5; Group 3, 4.1 +/- 2.1; and Group 4 , 2.2 +/- 0.7); and 3) ICU medicosurgical supplies (Group 1, 1.7 +/- 0 .8; Group 2, 2.0 +/- 1.5; Group 3, 3.7 +/- 1.7; and Group 4, 2.0 +/- 3 .0). It is concluded that cost containment strategies should be based on cost rather than charge and novel approaches will be required to re duce the cost of treating patients with SAH. Such approaches might inc lude preventing vasospasm, reducing ICU stay, selective use of arterio graphy, and reducing the cost of supplies.