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The Effect of Morbid Obesity on Subarachnoid Hemorrhage Prognosis in the United States.

Research paper by Ross-Jordon S RS Elliott, Daniel Agustin DA Godoy, Joel E JE Michalek, Réza R Behrouz, Marwah A MA Elsehety, Shaheryar S Hafeez, Denise D Rios, Ali A Seifi

Indexed on: 24 Jun '17Published on: 24 Jun '17Published in: World Neurosurgery



Abstract

The association between obesity and non-traumatic subarachnoid hemorrhage (SAH) patient outcome is unclear.Determine the impact of morbid obesity (body mass index ≥40 kg/m(2)) on non-traumatic SAH outcomes.Using the Nationwide Inpatient Sample, we identified hospitalized, non-traumatic SAH patients diagnosed from 2008 to 2013 and tested the effect of obesity on their mortality and clinical outcomes. Odds ratios were estimated with a mixed effects linear logistic model with adjustment for hospital clustering. All statistical testing was two-sided with a significance level of 5%. SAS Version 9.4 for Microsoft Windows (SAS Institute, Cary, North Carolina) was used.Out of 224,561 discharges with a diagnosis of non-traumatic SAH, 4,714 (2.10%) were defined as morbidly obese. Patients with morbid obesity were younger (54.3 ±0.44 versus 59.5 ±0.08 years; p<0.001) and had longer length of stay (LOS) (13 ±0.46 versus 11.5 ±0.06 days; p=0.002). Morbid obesity was associated with significantly higher hospital costs (p<0.001) and charges (p<0.001). The risk of acute respiratory failure was higher in morbidly obese patients (OR 1.49, 95% CI: 1.3-1.71, p<0.001). In a multivariate analysis of hospital mortality, obesity had a negative impact on mortality (OR 0.83, 95% CI: 0.74-0.92, p< 0.001). Overall, in-hospital mortality was associated with age, morbid obesity, LOS, clipping and coiling, acute respiratory failure, but not the symptomatic vasospasm.Morbid obesity is associated with increased LOS, hospital costs, charges, and acute respiratory failure. However, it is also associated with a decrease in hospital mortality.