Impact of blood pressure on the outcomes of inpatients with Subarachnoid hemorrhage: A retrospective cross-sectional study

Effect of blood pressure on recovery outcomes in inpatients with atherothrombotic infarction: A retrospective cross-sectional study

Stroke is one of the leading causes of death worldwide, and the relationship between blood pressure (BP) and outcomes after atherothrombotic infarction has been studied from various perspectives. However, the relationship of BP with rehabilitation outcomes and activities of daily living after atherothrombotic infarction has not been studied extensively. This study aims to investigate the effect of BP on rehabilitation outcomes and activities of daily living after atherothrombotic infarction. In this retrospective cross-sectional study, we analyzed data obtained from the Japan Association of Rehabilitation Database for inpatients undergoing rehabilitation using Wilcoxon's test, Pearson's chi-squared test, or Fisher's exact test. The patients were initially categorized into hypertensive and non-hypertensive groups and were assessed using the 10-item Barthel index (BI) activities and total BI at hospital discharge. The patients were further dichotomized into dependent (patients with scores of 0 for each activity) and nondependent groups based on the BI activities. Compared with hypertensive conditions (n = 108), non-hypertensive conditions (n = 213) were associated with higher dependence (feeding, transfers, toilet use, dressing, and bowel and bladder control). The proportion of non-hypertensive patients with a severely low BI (0-15) was higher than that of hypertensive patients. The hypertensive group had a greater increase in the BI (25 vs 15, P = .006) and daily BI (1.2 vs 0.74, P = .014) than the non-hypertensive group. During in-hospital rehabilitation, hypertensive patients recovered more efficiently than their non-hypertensive counterparts, emphasizing the need for personalized rehabilitation plans based on their individual BP profiles. Our results underscore the impact of BP on inpatients after atherothrombotic infarction, indicating that more non-hypertensive inpatients are affected by BP while receiving treatment than are hypertensive inpatients during rehabilitation.

Impact of obesity and diabetes on postoperative outcomes following surgical treatment of nontraumatic subarachnoid hemorrhage: Analysis of the ACS-NSQIP Database

BACKGROUND

Nontraumatic subarachnoid hemorrhage (SAH) refers to high pressure extravasation of blood into the subarachnoid space that typically occurs spontaneously from rupture of cerebral aneurysm. The purpose of this study was to identify postoperative complications requiring increased surveillance in obese, diabetic, and hypertensive patients.

METHODS

Patients who underwent surgical treatment for nontraumatic SAH were queried in the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from the years 2012-2018. Cases were identified using ICD codes and then classified independently by three dichotomous diagnoses: obesity, diabetes, and hypertension.

RESULTS

Among 1,002 patients meeting inclusion criteria, 311 (31%) were obese (BMI >30), 86 (9%) had diabetes treated with insulin or non-insulin agents and 409 (41%) required medication for hypertension. There was a statistically significant association between diabetes and post-operative pneumonia (OR = 1.694; 95% CI 0.995 - 2.883; p = 0.050), prolonged ventilator dependence (OR = 1.700; 95% CI 1.087 - 2.661; p = 0.019), and death (OR = 1.846; 95% CI 1.071 - 3.179; p = 0.025). Medicationdependent hypertension was statistically associated with incidence of stroke/CVA (OR = 1.763; 95% CI 1.056 - 2.943; p = 0.023). Obesity was not associated with adverse outcomes in this population.

CONCLUSIONS

In patients undergoing surgical management of SAH, hypertensive and diabetic patients had poorer outcomes, including prolonged ventilator dependence, pneumonia, stroke/CVA, and death. Surprisingly, preexisting obesity was not associated with poor outcomes. In fact, overweight BMI, Class I, and Class II obesity had decreased need for transfusion in the 30-day postoperative period.

Influence of socioeconomic status on the incidence of aneurysmal subarachnoid haemorrhage and clinical recovery

BACKGROUND

The relevance of socioeconomic status (SES) on the incidence of aneurysmal subarachnoid haemorrhage (aSAH) and discharge functional outcomes following treatment is not clear.

METHODS

A retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Information on patient characteristics, procedures performed, discharge disposition and SES were extracted. SES data was derived from classifications by the Australian Bureau of Statistics. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictor of unfavourable discharge outcomes (defined as death or dependency).

RESULTS

A total of 3,591 low SES patients (49.8%) were identified in our study cohort. Average crude incidence of aSAH was persistently higher among the SES disadvantaged (6.6 cases per 100,000 person-years, 95% CI 6.3 - 6.8), compared to the SES advantaged group (4.1 cases per 100,000 person-years, 95% CI 4.0-4.2) (p < 0.0001). Patients in the Low SES group were more likely to be active smokers, have type 2 diabetes mellitus, or live in non-metropolitan residence, and have overall worse discharge functional outcomes (27.7% versus 24.5%, p = 0.0015). Adjusting for well-established risk factors such as older age, and intracranial bleed (ICH and/or IVH), disadvantaged SES remained a significant predictor of poor discharge outcome following aSAH (p = 0.0003).

CONCLUSION

aSAH occurs more frequently among low SES communities, and once ruptured, there is a greater risk of poor recovery..