Incidence, hospital costs and in-hospital mortality rates of epidural hematoma in the United States

Abstract

Objective: This study provides the first United States (US) national data regarding frequency, cost and mortality rate of epidural hematoma (EDH) and determines the factors affecting the morbidity and deaths in the patients with EDH undergoing surgical evacuation.

Methods: A retrospective analysis was performed by searching the Nationwide Inpatient Sample (NIS) from 2003 to 2010, the largest all payer database of non-federal community hospitals in the US. All cases of EDH were indentified using ICD-9 codes.

Results: A total of 5189 admissions were identified in the NIS database, and incidence was highest in the second decade (33.4%). The median length of stay in the hospital was about 4 days in each year (2003-2010) without significant difference. The percent of discharge disposition other than home was about 2-3% in the entire cohort, with the highest in 2009 (3%). The average cost per admission increased significantly (80%) from $45,850 in 2003 to $82,800 in 2010. The inhospital mortality and complication rate was 3.5% and 2.9%, respectively. Factors affecting in-hospital mortality rate were age (≤18 yr vs. >18 yr, P<0.001), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital volume (high vs. low volume, P<0.001), physician's case volumes (high vs. low volume, P<0.02), hospital type (teaching vs. non-teaching, P<0.01) and hospital region (South vs. others, P<0.02). Similarly, factors affecting adverse outcome at discharge were age (≤18 yr vs. >18 yr, P<0.001), female gender (P<0.001), median income (fourth quartile vs. other, P<0.001), ethnicity (African-American vs. non-African-American, P<0.02), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital case volume (4th quartile volume vs. other, P<0.001), physician's case volume (4th quartile volume vs. other, P<0.0001), hospital type (teaching vs. non-teaching, hospital bed size (small vs. large, P<0.001), hospital region (Northeast vs. others, P<0.001) and hospital location (urban vs. rural, P<0.001).

Conclusion: Nationally, there has been no significant change in the frequency of EDH. However, its cost is increasing rapidly.

Keywords: Epidural hematoma; Hospital cost; In-hospital mortality; National in-patient sample.