The Impact of Congestive Heart Failure on Short-Term In-Hospital Outcomes in Patients undergoing Microsurgical Clipping for Ruptured and Unruptured Cerebral Aneurysms

Background:
One procedure to treat ruptured and unruptured cerebral aneurysms is microsurgical clipping (MC). Previous studies have explored clinical outcomes for this intervention. This study aims to further investigate short-term outcomes of patients after microsurgical clipping by looking at the impact of congestive heart failure (CHF).

Methods:
This retrospective cohort study utilized data from the Nationwide Inpatient Sample (NIS) to identify adult patients (18+) from 2012-2014 with the primary diagnosis of cerebral aneurysm (unruptured and ruptured) who underwent MC intervention. ICD-9 codes identified these patients and further identified patients specifically with CHF. Any patients missing important clinical identifiers (age, gender, cause of death) and patients who did not undergo MC were excluded. Data analyses assessed hospital length of stay (LOS), inpatient charges, average age of admission and mortality rate.

Results:
Of the 4,174 encounters with the diagnosis cerebral aneurysm that underwent MC, 87 patients had the diagnosis of CHF. LOS in patients with cerebral aneurysm who underwent MC was significantly increased (15.36 days, CHF group vs. 11.95 days, No CHF, p = 0.013). Total hospital charges were significantly increased ($323,794.05, CHF vs. $225,471.21, No-CHF p = 0.008). Mean mortality rate of patients was significantly increased (5.3%, CHF vs. 1.9%, No-CHF, p = 0.002). Mean age of patients was significantly increased (60.63 vs. 55.14 years, p < 0.0001).

Conclusions:
Patients with CHF who are diagnosed with cerebral aneurysm and undergo MC suffer from longer LOS, increased total hospital charges and increased mortality rate. This study aims to provide physicians with information in the management of patients with CHF who undergo MC. One limitation of this study is the inability to determine the severity of CHF in this patient population. Periprocedural optimization of symptomatic patients is one potential avenue for lowering LOS, total in-hospital charges and mortality.