1152. National Trends in Cerebral Bypass Surgery in the United States

Authors: Ethan Winkler, MD, PhD; John Yue, MD; Hansen Deng, BS; Caleb Rutledge, MD; Jan-Karl Burkhardt, MD; Adib Abla, MD (San Francisco, CA)

Introduction: Cerebral bypass augments or replaces cerebral blood flow when treating a number of brain vascular diseases. With advances in endovascular therapy and evolving evidence-based guidelines, it has been suggested that cerebral bypass procedures are in a state of decline. Here, we characterize the national trends in adult cerebral bypass surgery in the United States from 2002-2014. Methods: Using the Nationwide Inpatient Sample, all adult patients (≥ 18 years-old) undergoing cerebral bypass identified by ICD-9 procedure code 34.28 were extracted for analysis. Indications for bypass procedures, patient demographics, health care costs and regional variation are described. Results are stratified by indication for cerebral bypass. Predictors of complications and mortality were evaluated using multivariable logistic regression analysis. Results: From 2002-2014, there was an increase in the annual number of cerebral bypass surgeries performed in the United States. This reflected a growth in the number of cerebral bypass performed for adult moyamoya disease. Cases performed for occlusive vascular disease or cerebral aneurysms have declined. Inpatient complication rates for cerebral bypass in moyamoya disease, vascular occlusive disease and cerebral aneurysm is 13.2%, 25.1% and 56.3%, respectively. Mortality rates range from 0.3% to 7.8%. Multivariate logistic regression confirmed cerebral bypass for vascular occlusive disease or cerebral aneurysms are statistically significant predictors of inpatient complication and mortality. Mean health care costs of cerebral bypass are unchanged and vary with treatment indication: moyamoya disease ($38,406 ± 483), vascular occlusive disease ($46,618 ± 774), and aneurysm ($111,753 ± 2381). Conclusion: Cerebral bypass surgeries for adult revascularization have increased in the United States from 2002-2014. Rising rates of surgical bypass are the result of a greater proportion of surgery performed for moyamoya disease, while cases for vascular occlusive disease and aneurysms are decreasing. Despite evolving indications, cerebral bypass remains an important surgical tool in the modern endovascular era.