P-053 Delayed presentations, increased complications, and worse outcomes after aneurysmal subarachnoid hemorrhage in the COVID-19 Era

Introduction The COVID-19 pandemic has led to excess mortality out of proportion to documented COVID-19 cases while also affecting the care of non-COVID-19 related diseases. No data exist on the effects of the COVID-19 pandemic on the care and outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). Here we determine the impact of the COVID-19 pandemic on latency to presentation and clinical outcomes for aneurysmal subarachnoid hemorrhage. Methods We performed a retrospective cohort study of all patients presenting to a single center in Atlanta, Georgia, USA with aSAH between 2012 and 2020. COVID-19 was first reported in Georgia on March 2, 2020. All patients presenting from March 2nd through June 30th of a given calendar year were compared from the pre-COVID-19 era (2012- 2019) to the COVID-19 era (2020). Patient characteristics, latency from ictus to presentation, and clinical outcomes were compared. Every index digital subtraction angiogram was scored for the presence of vasospasm, and all cranial imaging studies were reviewed for infarcts consistent with delayed cerebral ischemia. Results 470 patients presented with aneurysmal subarachnoid hemorrhage during the study period. 433 and 37 presented before and during the COVID-19 era, respectively. Compared to the pre-COVID-19 era patients, patients presenting during the early phase of the pandemic were more likely to delay presentation (2.3 ± 1.3 days vs. 0.9 ± 2.2 days, respectively, p<0.01). Delays to presentation were driven by low and mid-grade subarachnoid hemorrhage patients (2.8± 3.1 days vs. 1.0 ± 2.2 days, p<0.01) with no differences noted in high-grade subarachnoid hemorrhage patients. The COVID-19 era was independently associated with significantly increased rates of angiographic vasospasm on presentation (aOR 2.52, 1.01 - 6.29, p = .048), delayed cerebral ischemia (aOR 3.84, 1.74 - 8.50, p=.001), and in-hospital aneurysmal re-rupture (aOR 5.75, 1.05 - 31.54, p=.044). Presentation during the COVID-19 era was independently associated with increased in-hospital death or hospice disposition in adjusted analysis (aOR 3.05, 1.03 - 9.04, p=0.04). Conclusions In this retrospective cohort, aSAH the COVID-19 era is associated with delayed presentation and attendant increases in cerebral vasospasm, delayed cerebral ischemia, aneurysmal re-rupture, and increased in-hospital mortality/hospice disposition. These data demonstrate a novel association between the COVID-19 pandemic and aneurysmal subarachnoid hemorrhage care, highlighting increases in overall mortality in non-COVID-19 associated disease driven by the ongoing pandemic.