Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage after Transitioning from Neurosurgery Led Care to a Neurology Led Multidisciplinary Approach

Abstract

Introduction—The limited research on the management of aneurysmal subarachnoid hemorrhages
(aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients’
outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidis‐
ciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisci‐
plinary care would improve patient outcomes.
Methods—This was a retrospective cohort study. We included patients (≥ 18) with aSAHs from 1/16 to
8/16 (pregroup) and from 3/17 to 11/17 (postgroup). The pregroup care was led by a neurosurgeon. The
postgroup care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist,
a neurosurgeon, and euvolemia protocol. The primary outcome was trips to interventional radiology (IR)
for vasospasm treatment. Univariate analyses and multivariable ordinal logistic regression were used.
Results—There were 99 patients included: 50 in the pregroup and 49 in the postgroup. On average, post‐
group patients were 7 years older than the pregroup (p = 0.05); no other demographic or clinical character‐
istics significantly differed. The odds were 62% lower that the postgroup had a higher number of trips to IR
for vasospasm treatment, when compared to the pregroup, p < 0.001.
Conclusions—In aSAH patients, the neurology-led multidisciplinary care in the NCCU decreased the
odds of repeated procedures for vasospasm treatment. Neurology-led multidisciplinary care could be more
cost-effective than the neurosurgical-led care.