Predictors of hospital-associated complications prolonging ICU stay in patients with low-grade aneurysmal subarachnoid hemorrhage

Nikolaos Mouchtouris, Michael J. Lang, Kaitlyn Barkley, Guilherme Barros, Justin Turpin, Ahmad Sweid, Robert M. Starke, Nohra Chalouhi, Pascal Jabbour, Robert H. Rosenwasser, Stavropoula Tjoumakaris

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: The authors sought to determine the predictors of late neurological and hospital-acquired medical complications (HACs) in patients with low-grade aneurysmal subarachnoid hemorrhage (aSAH). Methods: The authors conducted a retrospective study of 424 patients with low-grade aSAH admitted to their institution from 2008 to 2015. Data collected included patient comorbidities, Hunt and Hess (HH) grade, ICU length of stay (LOS), and complications. A logistic regression analysis was performed to determine the predictors for neurological and hospital-associated complications. Results: Out of 424 patients, 50 (11.8%) developed neurological complications after the first week, with a mean ICU stay of 16.3 ± 6.5 days. Of the remaining 374 patients without late neurological complications, 83 (22.2%) developed late HACs with a mean LOS of 15.1 ± 7.6 days, while those without medical complications stayed 11.8 ± 6.2 days (p = 0.001). Of the 83 patients, 55 (66.3%) did not have any HACs in the first week. Smoking (p = 0.062), history of cardiac disease (p = 0.043), HH grade III (p = 0.012), intraventricular hemorrhage (IVH) (p = 0.012), external ventricular drain (EVD) placement (p = 0.002), and early pneumonia/urinary tract infection (UTI)/deep vein thrombosis (DVT) (p = 0.001) were independently associated with late HACs. Logistic regression showed early pneumonia/UTI/DVT (p = 0.026) and increased HH grade (p = 0.057) to be significant risk factors for late medical complications. Conclusions: While an extended ICU admission allows closer monitoring, low-grade aSAH patients develop HACs despite being at low risk for neurological complications. The characteristics of low-grade aSAH patients who would benefit from early discharge are reported in detail.

Original languageEnglish (US)
Pages (from-to)1829-1835
Number of pages7
JournalJournal of neurosurgery
Issue number6
StatePublished - Jun 2020


  • Aneurysm
  • Critical care
  • Hospital-acquired complications
  • Subarachnoid hemorrhage
  • Vascular disorders
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Predictors of hospital-associated complications prolonging ICU stay in patients with low-grade aneurysmal subarachnoid hemorrhage'. Together they form a unique fingerprint.

Cite this