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Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States

Clinical article

Paul Kalanithi Department of Neurosurgery, Stanford University Hospitals and Clinics, and Outcomes Research Center, VA Palo Alto Health Care System, Palo Alto; and

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 M.D.
,
Ryan D. Schubert Stanford University School of Medicine, Stanford, California

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 B.S.
,
Shivanand P. Lad Department of Neurosurgery, Stanford University Hospitals and Clinics, and Outcomes Research Center, VA Palo Alto Health Care System, Palo Alto; and

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 M.D., Ph.D.
,
Odette A. Harris Department of Neurosurgery, Stanford University Hospitals and Clinics, and Outcomes Research Center, VA Palo Alto Health Care System, Palo Alto; and

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 M.D., M.P.H.
, and
Maxwell Boakye Department of Neurosurgery, Stanford University Hospitals and Clinics, and Outcomes Research Center, VA Palo Alto Health Care System, Palo Alto; and

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 M.D.
Page Range:
1013–1018
Volume/Issue:
Volume 115: Issue 5
DOI link:
https://doi.org/10.3171/2011.6.JNS101989
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Object

This study provides the first US national data regarding frequency, cost, and mortality rate of traumatic subdural hematoma (SDH), and identifies demographic factors affecting morbidity and death in patients with traumatic SDH undergoing surgical drainage.

Methods

A retrospective analysis was conducted by querying the Nationwide Inpatient Sample, the largest all-payer database of nonfederal community hospitals. All cases of traumatic SDH were identified using ICD-9 codes. The study consisted of 2 parts: 1) trends data, which were abstracted from the years 1993–2006, and 2) univariate analysis and multivariate logistic regression of demographic variables on inhospital complications and deaths for the years 1993–2002.

Results

Admissions for traumatic SDH increased 154% from 17,328 in 1993 to 43,996 in 2006. Inhospital deaths decreased from 16.4% to 11.6% for traumatic SDH. Average costs increased 67% to $47,315 per admission. For the multivariate regression analysis, between 1993 and 2002, 67,864 patients with traumatic SDH underwent operative treatment. The inhospital mortality rate was 14.9% for traumatic SDH drainage, with an 18% inhospital complication rate. Factors affecting inhospital deaths included presence of coma (OR = 2.45) and more than 2 comorbidities (OR = 1.60). Increased age did not worsen the inhospital mortality rate.

Conclusions

Nationally, frequency and cost of traumatic SDH cases are increasing rapidly.

Abbreviations used in this paper:

GCS = Glasgow Coma Scale; LOS = length of stay; NIS = Nationwide Inpatient Sample; SDH = subdural hematoma.
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Contributor Notes

* Drs. Kalanithi and Schubert contributed equally to this study.

Address correspondence to: Paul Kalanithi, M.D., Department of Neurosurgery, Lane Building, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, California 94305. email: paul.kalanithi@gmail.com.

Please include this information when citing this paper: published online August 5, 2011; DOI: 10.3171/2011.6.JNS101989.

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