Treatment at Safety-Net Hospitals Is Associated with Delays in Coil Embolization in Patients with Subarachnoid Hemorrhage

INTRODUCTION: Successful endovascular management of aneurysmal subarachnoid hemorrhage (aSAH) requires timely access to significant resources. Prior studies suggest an association between time to treatment and patient outcome. Patients treated at safety- net hospitals are thought to be particularly vulnerable to disparities in access to interventions that require substantial technological resources. We hypothesize that patients treated at safety-net hospitals are at greater risk for delayed access to endovascular treatment. MATERIALS AND METHODS: Adults undergoing endovascular coiling procedures between 2002–2011 in the Nationwide Inpatient Sample were included. Hospitals in the quartile with the highest proportion of Medicaid or uninsured patients were defined as safety-net hospitals. A multivariable model including patient and hospital-level factors was constructed to permit analysis of delays in endovascular treatment (defined as time to treatment greater than 3 days). RESULTS: Analysis included 7,109 discharges of patients with aSAH undergoing endovascular coil embolization procedures from 2002–2011. The median time to coil embolization in all patients was 1 day; 10.1% of patients waited more than three days until treatment. In multivariable analysis, patients treated at safety-net hospitals were more likely to have a prolonged time to coil embolization (OR 1.32, p