The nationwide burden of neurological conditions requiring emergency neurosurgery

Background: Neurosurgical emergencies are an important cause of disability and mortality. Objective: To examine the nationwide burden of neurological conditions requiring emergency neurosurgery. Methods: The Nationwide Inpatient Sample database (2002-2011) was queried to identify adult patients with a primary discharge diagnosis of a neurosurgical condition who were admitted urgently/emergently or through a trauma center and underwent surgical interventionwithin 2 days of admission. Diagnostic groupswere ranked based on their inpatient complication and mortality burden, and their contribution to total complications, deaths, hospital charges, and length of stay (LOS) was assessed. All analyses were weighted to produce national estimates. Results: After application of discharge weights, 810 404 patients who underwent emergency neurosurgery were identified. The average complication rate for the entire sample was 8.8%, themortality rate was 11.2%, average chargeswere $106 802, and average LOS was 9.0 days. The top 4 diagnostic groups ranked by complication/mortality burden accounted for 76% of all complications, 96% of all deaths, 81% of all charges, and 82% of all days in the hospital for the entire study sample. This was equal to 62 648 complications, 86 683 deaths, $69 billion in charges, and 5962 932 days. These 4 diagnostic groups included (1) acute cerebrovascular disease, (2) intracranial injury, (3) spinal cord injury, and (4) occlusion or stenosis of precerebral arteries. Conclusion: Acute cerebrovascular disease, intracranial injury, spinal cord injury, and occlusion/stenosis of precerebral arteries requiring emergency neurosurgery carry an important nationwide burden in terms of complications, deaths, charges, and LOS. Efforts in prevention and/or treatment of these conditions should continue.