Room utilization analysis of pre-operative glue embolization for venous malformations: procedure times and outcomes.

BACKGROUND

Pre-operative n-butyl-2-cyanoacrylate embolization and surgical resection is an established treatment for venous malformations. A single-session treatment is optimal but requires accurate procedural time estimates for the interventional radiology and surgical portions of the treatment to optimize coordination. Understanding the variables affecting room time could improve coordination, raise efficiency, and eventually help to estimate cost for patients.

OBJECTIVE

Identify which factors have a significant impact on the room time for pre-operative glue embolization of venous malformations.

MATERIALS AND METHODS

A single institution, institutional review board-approved, retrospective study of glue embolization procedures was performed over an 8-year period. The impacts of patient, operator, technical factors, and malformation characteristics on procedure time and room time were analyzed using univariate and multivariate log-transformed linear mixed models to account for data skewedness.

RESULTS

A total of 232 patients were identified with a median age of 13 years (IQR, 8.5; 16 years) and median weight of 48 kg (IQR, 27; 64 kg). Higher Puig's classification number (β range, -0.04-0.41; P=0.02), larger malformation dimension (β=0.0031; P<0.001), use of cone beam CT (β=0.29; P<0.001), and the presence of adverse events (β=0.54; P<0.001) significantly increased procedure time on multivariate analysis. The presence of an adverse event (β=0.3100; P<0.001), use of cone beam CT utilization (β=0.1600; P<0.001), and larger venous malformation dimension (β=0.0017; P<0.001) significantly lengthened total room time. The performing physician additionally impacted both total room times (P<0.001); however, the experience level with glue embolization varied significantly between providers (P<0.001) and was felt to be a contributing factor.

CONCLUSION

The room time required for n-butyl-2-cyanoacrylate embolization prior to venous malformation resection is significantly dependent on the presence of complications, cone beam CT use, malformation size, and performing physician experience.