Abstract Body: Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality. Survivors often require extended care at skilled nursing facilities (SNF) or long-term acute care centers (LTAC). The need for long-term institutional care and distribution of patients returning to independence is unclear. We sought to identify predictors of discharge from extended care facilities to home in aSAH patients.
Methods: We conducted a retrospective review of a prospectively maintained database of aSAH patients treated at a single center from June 2016 to March 2024. Included patients were discharged from the hospital to an extended care facility. Patients were grouped by whether they were discharged from extended care to home and the estimated facility length of stay (LOS) was determined. Demographics, aSAH characteristics, hospital complications, and post-aSAH neurological status were analyzed. Predictors of extended care facility discharge to home were determined using independent-sample t-tests, Fisher analyses, and multivariable logistic regression. Facility LOS predictors were identified using cumulative link modeling.
Results: Of 450 aSAH patients, 61 (13.5%) were discharged to a SNF. No patients discharged to LTAC returned home and were not reviewed further. Among SNF patients, 49 (80.3%) were discharged home (Figure 1). Discharged patients were younger (mean 63.3±11.5 years vs. 70.2±9.3, p=0.040; Figure 2) and had lower modified Fisher scores (3 [IQR 3-4] vs. 4 [IQR 4-4], p=0.046; Figure 3). Intraventricular hemorrhage (OR 0, 95% CI 0-1.12, p=0.043), tracheostomy (OR=0.14, 95% CI 0.14-1.01, p=0.048), and gastrostomy tube (PEG) placement (OR=0.13, 95% CI 0.03-0.51, p=0.003) were associated with lower odds of SNF discharge. Patients discharged home had shorter hospital LOS (26±10 vs. 39±15 days, p<0.001) and lower mRS scores at discharge (4 [IQR 4-5] vs. 5 [IQR 4-5], p=0.028) and 90-days post-discharge (4 [IQR 3-5] vs. 6 [IQR 5-6], p=0.001). Multivariable regression identified old age, PEG and hospital LOS as independent predictors of SNF discharge. Tracheostomy, PEG, and symptomatic vasospasm predicted SNF LOS.
Conclusions: A majority of aSAH patients were discharged from SNF to home. Those not discharged were more medically complex with neurological deficits. These results may guide goals of care discussions, suggesting that patients unfit for home discharge may benefit from SNF placement to bridge hospitalization and independence.