Abstract 355: Outcomes of Blood Transfusions in Non‐Traumatic Subarachnoid Hemorrhage: A US Nationwide Analysis
Authors: Jain A. , Aifuwa E. , Spirollari E. , Abraham E. , Thueyoo P. , Sacknovitz A. , Al‐Mufti F. 
Published: January 2025

Introduction/Purpose
Subarachnoid hemorrhage (SAH) is a life‐threatening condition characterized by bleeding into the space between the arachnoid membrane and pia mater surrounding the brain. Despite advancements in patient care, SAH remains associated with high morbidity and mortality rates. An element of SAH management that has garnered significant attention is the use of blood transfusions in patient care. Recent studies have raised concerns regarding the potential for transfusions to exacerbate negative outcomes in SAH patients. The purpose of the current study is to examine the patient characteristics, complications, and outcomes of blood transfusions in patients with SAH.

Methods
A query of the 2016‐2019 National Inpatient Sample (NIS) was performed for patients admitted to hospitals with ICD‐10 diagnosis codes for non‐traumatic SAH. Demographic and clinical information was analyzed for SAH patients who received blood transfusions during their inpatient admission compared to those who did not. Severity of presentation, complications, and other sequelae related to non‐traumatic SAH were also assessed. A multivariate binary logistic regression was performed to evaluate the outcomes of complications, prolonged length of stay, discharge disposition, and inpatient mortality, while controlling for age, gender, NIS‐Subarachnoid Hemorrhage Severity scores, and Elixhauser Comorbidity Index. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS, V. 28).

Results
A total of 183,965 patients with non‐traumatic SAH were identified from 2016‐2019. Patients who received blood transfusions had higher rates of sepsis (OR 2.936, 2.767‐3.115, p<0.001), deep vein thrombosis (OR 2.139, 1.983‐2.307, p<0.001), pulmonary embolism (OR 2.125, 1.9‐2.378, p<0.001), acute kidney injury (OR 3.336, 3.191‐3.487, p<0.001), tracheostomy (OR 3.417, 3.217‐3.628, p<0.001), hemiplegia (OR 1.078, 1.023‐1.135, p=0.005), herniation (OR 1.256, 1.189‐1.326, p<0.001), mechanical ventilation (OR 3.046, 2.917‐3.18, p<0.001), seizure (OR 1.263, 1.195‐1.336, p<0.001), and cerebral edema (OR 1.276, 1.22‐1.335, p<0.001), compared to patients who did not receive blood transfusions. With regards to clinical outcomes, SAH patients who received blood transfusions were more likely to experience prolonged length of stay (OR 3.466, 3.286‐3.656, p<0.001), transfer to a skilled nursing facility (OR 1.52, 1.456‐1.586, p<0.001), and death (1.563, 1.492‐1.638, p<0.001), in comparison to SAH patients who did not receive blood transfusions.

Conclusions
In this nationally‐representative study of inpatient data, SAH patients who received blood transfusions had higher risks of mortality, prolonged hospital stays, and increased rates of complications, compared to SAH patients who did not receive blood transfusions. Although our study was limited by lack of patient follow‐up and outpatient data, we underscore the need for longitudinal studies to identify the timeframe and potential causes of these outcomes. Understanding the long‐term impact of blood transfusions in SAH patients is crucial for improving patient care and developing evidence‐based guidelines for transfusion practices in this high‐risk population.