1078. Effects of Neurovascular Comorbidities and In-Hospital Complications on Procedural Management of Unruptured Aneurysm
Authors: Pious D Patel; Silky Chotai, MD; Campbell Liles, BS; Heidi Chen, PhD; Shilin Zhao, PhD; Chevis Shannon; Matthew Fusco, MD; Rohan Chitale, MD (Nashville, TN)
Neurovascular comorbidities and complications can significantly affect aneurysm prognosis. For surgical and endovascular management of unruptured aneurysms, this study investigates the effects of comorbidities on in-hospital complications, and of comorbidity-adjusted complications on outcomes, in-hospital mortality, and length of stay (LOS).
Unruptured aneurysm patients were identified unweighted from the 2012-2015 National Inpatient Sample (NIS) using ICD-9 procedural/diagnostic codes for aneurysm treatment (Clipping 395.1; Coiling 395.2, 397.2, 397.9) in non-subarachnoid hemorrhage patients (430). Patients with head trauma, AVM/AVF, and LOS less than one day were excluded. Variables were comorbidities (measured with the neurovascular comorbidities index (NCI)), in-hospital complications (divided into seizures, medical complications, and surgical complications), and sociodemographic factors. Outcomes were modified Rankin scale equivalent outcome (NIS-SOM), in-hospital mortality, and LOS. Multivariable logistic regression models were built for NIS-SOM and in-hospital mortality. Multivariable linear regression models were built for LOS.
7,398 patients were included (median age 58, 75% female, 66% White, 43% private insurance). NCI was higher in patients with each type of in-hospital complication (P<.001) and any in-hospital complication (P<.001). In multivariate regressions, NCI was significantly associated with poor NIS-SOM (P<.001), increased in-hospital mortality (P<.001), and longer LOS (P<.001). In-hospital complications were significantly associated with poor NIS-SOM (P<.001) and longer LOS (P<.001), but not in-hospital mortality (P=.71). The presence of a surgical complication strengthened the association between NCI and NIS-SOM. The presence of any in-hospital complication strengthened the association between NCI and LOS (P<.001).
Among patients undergoing procedural management of unruptured aneurysms, we found that comorbidities are associated with higher occurrence of in-hospital complications. Comorbidities are strongly associated with poor outcomes, and the presence of in-hospital complications magnifies these effects for NIS-SOM outcome and LOS. The dynamic relationship between comorbidities and in-hospital complications should be further defined for effective preoperative risk discussions in unruptured aneurysm patients.