• Ben A Strickland, Melissa Mert, Kristine Ravina, Alex Chartrain, Robert C Rennert, Joshua Bakhsheshian, Shane Shahrestani, Anna Jackanich, Arun Amar, William Mack, Jonathan J Russin, and Steven L Giannotta.
• Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Electronic address: ben.strickland@med.usc.edu.
• World Neurosurg. 2020 Jun 1; 138: e787-e794.

ObjectiveTo investigate potential health care discrepancies in patients with ruptured cerebral aneurysms undergoing microsurgical intervention.MethodsWe retrospectively reviewed patients with ruptured intracranial aneurysms treated at our tertiary referral university hospital (UH) and safety net county hospital (CH) from 2010 to 2015. We identified 73 UH patients and 58 CH patients.ResultsUH patients had shorter time duration between rupture and intervention (P < 0.001) and higher rates of intubation on admission (P = 0.01). Verapamil was more frequently used for clinical vasospasm in UH patients, at 0.13 (95% confidence interval [CI], 0.09-0.18) treatments per patient per day versus 0.077 (95% CI, 0.047-0.12) treatments per patient per day in CH patients, though there was no difference in delayed cerebral ischemia (P = 0.15). The majority of the CH cohort was uninsured (26.3%; UH 0%) or had Medicaid (59.7%; UH 35.2%) (P < 0.001). The UH had more dispositions to home or rehabilitation centers than the CH (82% vs. 67.3%; P = 0.04). After adjusting for disease severity, hospital stay, and insurance status, CH patients were 3.73 (95% CI, 1.25-12.14) times more likely to be discharged with a poor modified Rankin Scale score and 3.08 (95% CI, 1.04-9.61) times more likely to be discharged with a poor Glasgow Outcome Scale score compared with UH patients (P = 0.02 and P = 0.04, respectively).ConclusionsLimited resource availability in a safety net hospital system could be a major driving force behind the health care discrepancy identified in our ruptured cerebral aneurysm population. Reallocation of resources to supplement advanced inpatient acute care technologies and, more importantly, post-acute care environments can narrow the outcomes gap.Copyright © 2020 Elsevier Inc. All rights reserved.

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