McPheeters Matthew J, Waqas Muhammad, Lim Jaims, Rho Kyungduk, Jaikumar Vinay, Gong Andrew, Raygor Kunal P, Housley Steven B, Scullen Tyler A, Bouslama Mehdi, Levy Elad I
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA.
Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA.
Neurosurgery. 2024 Dec 3;97(1):234-241. doi: 10.1227/neu.0000000000003295.
The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies.
We performed a retrospective analysis on the data of healthy (Charlson Comorbidity Index ≤4) adult patients undergoing elective neurosurgical procedures including endovascular repair of UIAs, ACDF, and discectomy between January 1, 2012, and August 31, 2019, at a single tertiary facility. Clinical complications and outcomes data were collected and analyzed. The primary outcome variable was the 30-day readmission rate with subgroup analyses of readmission <48 hours and 48 hours to 30 days.
A total of 586 patients and a total of 606 procedures were identified, comprising 205 endovascular UIA treatments, 201 ACDFs, and 200 discectomies. Fourteen UIA procedures were excluded from analysis (n = 191) on the basis of anatomic high-risk features. For the primary outcome, there was no statistically significant difference in 30-day readmission rates among the comparison groups ( P = .36). For the subgroup analyses, there were no differences in readmission rates for <48 hours ( P = .06) and 48 hours to 30 days ( P = .71). In addition, there was no significant difference in intraprocedural complication rates among the groups ( P = .19).
Inpatient elective endovascular treatment of UIAs had similarly low rates of intraprocedural complications and short-term readmissions compared with the established outpatient spine procedures. We hope that our findings may serve as the foundation for future, prospective studies assessing the safety and utility of performing endovascular procedures for UIAs in an outpatient setting.
为提高医疗成本效益，部分神经外科手术正从住院环境转向门诊环境进行。尽管在未破裂颅内动脉瘤（UIA）的治疗方面有众多技术进步，但这些手术仍仅在住院环境中进行。我们旨在比较UIA住院血管内治疗与既定门诊神经外科手术（包括颈椎前路椎间盘切除融合术（ACDF）和腰椎间盘切除术）相关的短期结局发生率。
我们对2012年1月1日至2019年8月31日在一家三级医疗机构接受包括UIA血管内修复、ACDF和椎间盘切除术等择期神经外科手术的健康（Charlson合并症指数≤4）成年患者的数据进行了回顾性分析。收集并分析临床并发症和结局数据。主要结局变量是30天再入院率，并对入院时间<48小时和48小时至30天进行亚组分析。
共确定了586例患者和606例手术，包括205例UIA血管内治疗、201例ACDF和200例椎间盘切除术。基于解剖学高风险特征，14例UIA手术被排除在分析之外（n = 191）。对于主要结局，比较组之间的30天再入院率无统计学显著差异（P = 0.36）。对于亚组分析，入院时间<48小时（P = 0.06）和48小时至30天（P = 0.71）的再入院率无差异。此外，各组之间的术中并发症发生率无显著差异（P = 0.19）。
与既定的门诊脊柱手术相比，UIA住院择期血管内治疗的术中并发症和短期再入院率同样较低。我们希望我们的研究结果可为未来评估门诊环境下UIA血管内手术安全性和实用性的前瞻性研究奠定基础。
