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Background/objective: Mild obesity is associated with a survival benefit in cardiovascular and cerebrovascular disease. Only a few studies have analyzed the effect of obesity on outcomes after spontaneous intracerebral hemorrhage (ICH), and none have used a national US database. We sought to determine whether or not obesity was associated with outcomes and in-hospital complications following ICH., Methods: The Nationwide Inpatient Sample was used to identify patients with ICH in the USA who were discharged between 2002 and 2011. The presence of obesity (body mass index [BMI] 30-39.9) or morbid obesity (BMI ≥ 40) was noted. The primary outcome of interest was in-hospital mortality, and secondary outcomes included non-routine discharge disposition, tracheostomy or gastrostomy placement, length of stay (LOS), inflation-adjusted hospital charges, and in-hospital complications., Results: A total of 123,415 patients with ICH met the inclusion criteria, and the 10-year overall incidence of obesity was 4.5%. Between 2002 and 2011, the incidence of obesity increased from 1.9 to 4.4% and the incidence of morbid obesity increased from 0.7 to 3.2%. Both obese (OR 0.62, 95% CI 0.56-0.69) and morbidly obese (OR 0.76, 95% CI 0.66-0.88) patients had lower odds of inpatient mortality. Obese (OR 0.85, 95% CI 0.78-0.93) but not morbidly obese patients had lower odds of non-routine discharge. Morbidly obese patients were twice as likely to require a tracheostomy than non-obese patients (OR 2.07, 95% CI 1.62-2.66). Both obese and morbidly obese patients had higher total hospital charges and rates of pulmonary, renal, and venous thromboembolic complications. There was no difference in LOS according to body habitus., Conclusions: In patients with spontaneous ICH, obesity is associated with decreased in-hospital mortality but higher rates of in-hospital complications and greater total hospital charges. Non-morbid obesity carries lower odds of non-routine hospital discharge.

Objective: Induced hypernatremia is frequently used to reduce intracranial pressure in patients with severe traumatic brain injury (TBI). This technique is controversial, and some studies have independently associated hypernatremia with worse outcomes after TBI. We sought to investigate this potential association in a large healthcare database., Methods: The Nationwide Inpatient Sample was used to obtain data on all adults who had been discharged from 2002 to 2011 with a primary diagnosis of TBI who required mechanical ventilation, intracranial pressure monitoring, or craniotomy/craniectomy. Patients with diabetes insipidus were excluded. The patients with hypernatremia were assigned to the hypernatremia group, and the rest were assigned to the control group. The primary outcome was in-hospital mortality, and the secondary outcomes included the length of stay, nonroutine hospital discharge, total hospital charges, tracheostomy, and gastrostomy placement., Results: A total of 85,579 patients without a diagnosis of hypernatremia (control group) and 4542 patients with a diagnosis of hypernatremia (hypernatremia group) were identified. When controlling for age, comorbidities, gender, and cerebral edema, hypernatremia was associated with an increased rate of in-hospital mortality (odds ratio, 1.51; 95% confidence interval, 1.39-1.65), a longer mean length of stay (23.65 vs. 12.12 days; P < 0.001), an increased rate of nonroutine hospital discharge (odds ratio, 2.58; 95% confidence interval, 2.28-2.92), and greater mean total hospital cost ($227,112 vs. $112,507; P < 0.001). The patients with hypernatremia also had greater rates of tracheostomy and gastrostomy placement., Conclusions: Hypernatremia was associated with poorer outcomes in patients with severe TBI. This finding warrants further investigation in a prospective, randomized study., (Copyright © 2018 Elsevier Inc. All rights reserved.)