In-hospital outcomes of aneurysmal subarachnoid hemorrhage associated with cocaine use in the USA

Abstract

Cocaine use is associated with higher mortality in small retrospective studies of brain-injured patients. We aimed to explore in-hospital outcomes in a large population based study of aneurysmal subarachnoid hemorrhage (aSAH) with cocaine use. aSAH patients were identified from the 2007-2010 USA Nationwide Inpatient Sample using International Classification of Disease, Ninth Revision codes. Demographics, comorbidities and surgical procedures were compared between cocaine users and non-users. The primary outcomes were in-hospital mortality and home discharge/self-care. Secondary outcomes were vasospasm treated with angioplasty, hydrocephalus, gastrostomy and tracheostomy. There were 103,876 patients with aSAH. The cocaine group were younger (45.8 ± 9.8 versus 58.4 ± 15.8, p<0.001), predominantly male (53.3% versus 38.5%, p<0.001) and had a higher proportion of black patients (36.9% versus 11.5%, p<0.001). The incidence of seizures was higher among cocaine users (16.2% versus 11.1%, p<0.001). Endovascular coiling of intracranial aneurysms (24% versus 18.5%, p<0.001) was more frequent in cocaine users. The univariate analysis showed higher rates of in-hospital mortality and vasospasm treated with angioplasty, but lower home discharge in the cocaine group. In the multivariate analysis, the cocaine cohort had higher in-hospital mortality (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27-1.61, p<0.001) and lower home discharge rates (OR 0.79, 95% CI 0.69-0.87, p<0.001) after adjusting for confounders. Rates of vasospasm treated with angioplasty however were similar between the two groups. Cocaine use was found to be independently associated with poor outcomes, particularly higher mortality and lower home discharge rates. Cocaine use however, was not associated with vasospasm that required treatment with angioplasty. Prospective confirmation is warranted.

Keywords: Cocaine use; Intracranial aneurysms; Nationwide Inpatient Sample; Subarachnoid hemorrhage.