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Medical Complications After Aneurysmal Subarachnoid Hemorrhage: Analysis of Trends in US Admissions from 2006 to 2022

Sabra, A.; Philip, K.; Levin-Carrion, Y.; Ha, C.J.; Sahoo, A.; Huynh, T.; Landzberg, D.; Singla, A.; Liu, J.K.; Atchaneeyasakuul, K.; Khandelwal, P.; Otite, F.O.

Neurocritical Care 2026

2026

ISSN/ISBN: 1556-0961
PMID: 41709066
DOI: 10.1007/s12028-025-02443-6
Accession: 103548455

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Summary
To analyze trends in the prevalence of medical complications in aneurysmal subarachnoid hemorrhage (aSAH) hospitalizations in the USA over the last decade. A serial cross-sectional study was performed using the 2006-2022 National Inpatient Sample. Adult (≥ 18 years) primary aSAH hospitalizations with and without complications were identified using International Classification of Diseases codes. Negative binomial regression models were used to evaluate the associations between complications, individualized hospitalization characteristics, and hospital outcomes. Of 163,349 aSAH hospitalizations over the study period, 68.2% were female. The mean age was 55.6 years, and this increased over time (p-trend < 0.001). The mean National Inpatient Sample Subarachnoid Severity Score was 5.5 [standard error (SE) 0.06] and this also increased over time. Overall, 42.4% of hospitalizations had ≥ 1 medical complication. Urinary tract infections (UTI) (19.4%), pneumonia (15.4%), and sepsis (8.0%) were the most prevalent complications, while acute renal failure (ARF) (7.8%) was the most frequent noninfectious complication. The age- and sex-standardized prevalence of any medical complication remained stable over this study period, but there was marked heterogeneity in prevalence trends by complication type. ARF prevalence increased by nearly 300% [prevalence rate ratio (PRR): 1.04 per year, 95% confidence interval (CI): 1.02-1.04, p < 0.001] and deep venous thrombosis (DVT) prevalence increased by more than 200% (PRR:1.03, 95% CI: 1.01-1.04, p < 0.001) per year, while UTI and sepsis prevalence declined over this time (all p-trend < 0.001). Pneumonia prevalence declined in male only (p-trend < 0.05). Clipping was associated with higher DVT risk (PRR 1.24, 95% CI: 1.13-1.37) but lower gastrointestinal bleeding risk (PRR 1.14, 95% CI: 0.95-1.38) compared with coiling. All complications were significantly linked to poor outcomes (e.g., pneumonia: PRR 1.23, 95% CI: 1.20-1.30). The prevalence of infectious complications in aSAH has declined over the last decade, but this has been counterbalanced by a troubling increase in ARF and DVT prevalence. Given the strong association of all complications with poor outcomes, future studies focused on mitigating the prevalence of complications are needed to help improve aSAH outcomes.

References

Sabra, A.; Philip, K.; Levin-Carrion, Y.; Ha, C.J.; Sahoo, A.; Huynh, T.; Landzberg, D.; Singla, A.; Liu, J.K.; Atchaneeyasakuul, K.; Khandelwal, P.; Otite, F.O. 2026: Medical Complications After Aneurysmal Subarachnoid Hemorrhage: Analysis of Trends in US Admissions from 2006 to 2022 Neurocritical Care 2026
Wong, M.; Haley, E.C.; Kongable, G.; Parks, K.; Kassell, N.; Torner, J. 1989: Medical complications in the treatment of aneurysmal subarachnoid hemorrhage changing trends Neurology 39(3 Suppl 1): 160
Wahood, W.; Rizvi, A.A.; Alexander, A.Y.; Yolcu, Y.U.; Lanzino, G.; Brinjikji, W.; Rabinstein, A.A. 2022: Trends in Admissions and Outcomes for Treatment of Aneurysmal Subarachnoid Hemorrhage in the United States Neurocritical Care 37(1): 209-218
Solenski, N.; Haley, C.; Kassell, N.; Truskowski, L.; Kongable, G.; Germanson, T.; Torner, J. 1993: Medical complications of aneurysmal subarachnoid hemorrhage Neurology 43(4 Suppl 2): A341-A342
Warnell, P. 1992: The cardiopulmonary complications of aneurysmal subarachnoid hemorrhage: current trends in management Axone 14(1): 24-28
Solter, V.V.; Roje-Bedeković, M.; Breitenfeld, T.; Supanc, V.; Lovrencić-Huzjan, A.; Serić, V.; Antoncić, I.; Basić, S.; Beros, V.; Bielen, I.; Soldo, S.B.ć; Kadojić, D.; Lusić, I.; Maldini, B.; Marović, A.; Paladino, J.; Poljaković, Z.; Radanović, B.; Rados, M.; Rotim, K.; Vukić, M.; Zadravec, D.; Kes, V.B.ć 2014: Recommendations for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage Acta Clinica Croatica 53(1): 113-138
Rose, M.J. 2011: Aneurysmal subarachnoid hemorrhage: an update on the medical complications and treatments strategies seen in these patients Current Opinion in Anaesthesiology 24(5): 500-507
Etminan, N.; Macdonald, R.Loch. 2015: Medical complications after aneurysmal subarachnoid hemorrhage: an emerging contributor to poor outcome World Neurosurgery 83(3): 303-304
Lenkeit, A.; Oppong, M.D.; Dinger, T.F.; Gümüs, M.; Rodemerk, J.; Chihi, M.; Ahmadipour, Y.; Uerschels, A.-K.; Dammann, P.; Deuschl, C.; Wrede, K.H.; Sure, U.; Jabbarli, R. 2023: The role of previous medical history and secondary complications for the outcome of aneurysmal subarachnoid hemorrhage in elderly patients Clinical Neurology and Neurosurgery 235: 108027
Vasconcellos de Oliveira Souza, N.ál.; Rouanet, C.; Fontoura Solla, D.J.; Barroso de Lima, C.V.íc.; Trevizo, J.; Rezende, F.; Alves, M.M.; de Oliveira Manuel, A.L.; Righy, C.; Chaddad Neto, F.; Frudit, M.; Silva, G.S. 2024: Impact of Medical and Neurologic Complications on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage in a Middle-Income Country World Neurosurgery 183: E250-E260
Turner, C.L.; Budohoski, K.; Smith, C.; Hutchinson, P.J.; Kirkpatrick, P.J.; Murray, G.D.; Sir G Teasdale; Murray, G.D.; Kirkpatrick, P.J.; Mendelow, A.D.; Muir, K.; Smith, M.; McCabe, P.; Pearson, J.; Ford, G.; Vail, A.; King, A.; Tyrrell, P.; Richards, H.; Turner, C.L.; Smith, C.; Warburton, E.; Kirkpatrick, P.J.; Turner, C.L.; Smith, C.; Belli, A.; Bulters, D.; Brown, M.; Critchley, G.; Spurling, G.; Gaylard, J.; Javadpour, M.; Eldridge, P.; Murray, L.; Nelson, R.; Taylor, R.; Hierons, S.; Tobin, B.; Storey, K.; Walsh, D.; Aeron-Thomas, J.; Puppo, C.; Papadopoulos, M.; Montague, L.; Gan, P.; Flint, G.; Hurley, J.; Ronne, E.; Stjernling, I.; Wang, E.; Cheng, E.L.; Low, K.W.; Ross, S.; Bellfield, R.; Mandizvidza, L.; Whitfield, P.; Persad, 2015: Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data from the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial Neurosurgery 77(5): 786-792; Discussion: 792-793
Theofanopoulos, A.; Fermeli, D.; Boulieris, S.; Kalantzis, G.; Kefalopoulou, Z.; Panagiotopoulos, V.; Papadakos, D.; Constantoyannis, C. 2021: Effects of COVID-19 on the admissions of aneurysmal subarachnoid hemorrhage: the West Greece experience Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 42(6): 2167-2172
Wong, G.K.C.; Poon, W.S.; Chan, M.T.V.; Boet, R.; Gin, T.; Ng, S.C.P.; Zee, B.C.Y. 2010: Plasma Magnesium Concentrations and Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients Post Hoc Analysis of Intravenous Magnesium Sulphate for Aneurysmal Subarachnoid Hemorrhage Trial Stroke (1970) 41(8): 1841-1844
Wong, G.K.C.; Poon, W.S.; Chan, M.T.V.; Boet, R.; Gin, T.; Ng, S.C.P.; Zee, B.C.Y. 2010: Plasma magnesium concentrations and clinical outcomes in aneurysmal subarachnoid hemorrhage patients: post hoc analysis of intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage trial Stroke 41(8): 1841-1844
Torregrossa, F.; Grasso, G. 2022: The Quest for Predictors of Shunt-Dependent Chronic Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Toward a Tailored Approach for Permanent Shunt-Dependency Following Aneurysmal Subarachnoid Hemorrhage World Neurosurgery 157: 96-98
Stienen, M.N.; Germans, M.; Burkhardt, J.-K.; Neidert, M.C.; Fung, C.; Bervini, D.; Zumofen, D.; Röthlisberger, M.; Marbacher, S.; Maduri, R.; Robert, T.; Seule, M.A.; Bijlenga, P.; Schaller, K.; Fandino, J.; Smoll, N.R.; Maldaner, N.; Finkenstädt, S.; Esposito, G.; Schatlo, B.; Keller, E.; Bozinov, O.; Regli, L.; Serra, C.; Krayenbühl, N.; Schöni, D.; Raabe, A.; Beck, J.ür.; Goldberg, J.; Mariani, L.; Guzman, R.; D'Alonzo, D.; Coluccia, D.; Daniel, R.T.; Starnoni, D.; Messerer, M.; Levivier, M.; Valsecchi, D.; Arrighi, M.; Venier, A.; Reinert, M.; Kuhlen, D.E.; Ferrari, A.; Weyerbrock, A.; Hildebrandt, G.; Hlavica, M.; Fournier, J.-Y.; Corniola, M. 2018: Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]) Stroke 49(2): 333-340
Dellinger, R.P. 2008: Cardiac complications after aneurysmal subarachnoid hemorrhage Yearbook of Critical Care Medicine 2008: 285-286
Seule, M.A.; Stienen, M.N.; Cadosch, D.; Fournier, J.-Y.; Lussmann, R.; Hildebrandt, G.; Gautschi, O.P. 2010: Aneurysmal subarachnoid hemorrhage - therapy and complications Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie: Ains 45(1): 8-17
Friedman, J.A.; Pichelmann, M.A.; Piepgras, D.G.; McIver, J.I.; Toussaint, L.Gerard.; McClelland, R.L.; Nichols, D.A.; Meyer, F.B.; Atkinson, J.L.D.; Wijdicks, E.F.M. 2003: Pulmonary complications of aneurysmal subarachnoid hemorrhage Neurosurgery 52(5): 1025-31; Discussion 1031-2
Garg, R.; Bar, B. 2017: Systemic Complications Following Aneurysmal Subarachnoid Hemorrhage Current Neurology and Neuroscience Reports 17(1): 7