Ventriculostomy: Frequency, length of stay and in-hospital mortality in the United States of America, 1988-2010

Abstract

Ventriculostomy is a common neurosurgical procedure. We evaluated a large national sample of data regarding epidemiologic trends in neurosurgical practice relating to ventriculostomy. The USA Nationwide Inpatient Sample (1988 to 2010) provided retrospective data on patients hospitalized who underwent a ventriculostomy procedure. We categorized ventriculostomy procedures as the principal procedure performed for definitive treatment or as any other procedure. We identified 101,577 relevant hospital admissions with an estimated national volume of 507,762 hospital admissions from 1988 to 2010. For all patients, the mean age was 45.0 years and 46.5% were female. The three most common individual principal diagnoses were subarachnoid hemorrhage (19.1%), intracerebral hemorrhage (14.9%), and obstructive hydrocephalus (3.8%). The three most common principal procedures were other excision or destruction of lesion or tissue of brain (16.0%), clipping of aneurysm (13.5%), and temporary tracheostomy (10.8%). Mean length of stay was 20.8 days and in-hospital mortality was 24.5%. In-hospital mortality was associated with emergency admission (multivariate odds ratio 1.98; 95% confidence interval 1.92-2.05), age 45 years or greater (mean of data set) (1.91; 1.85-1.98), multiple ventriculostomies (1.55; 1.44-1.67), and ventriculostomy as a principal procedure (1.39; 1.35-1.44). A total of 32.7% of patients were discharged to home. Most (94.3%) hospitalizations had one, 5.0% had two, and 0.7% multiple (three or more) ventriculostomies performed. Neurosurgeons must be aware of the association of in-hospital mortality, especially during the first days of admission, particularly when ventriculostomy is the principal procedure performed for definitive treatment during the hospitalization.

Keywords: Epidemiology; External ventricular drain; Nationwide inpatient sample; Ventricular shunt.