Abstract No. 572 National trends in inpatient intracranial arteriovenous malformation imaging and interventions from 2006 to 2014

Abstract

Listen

Translate article

To evaluate national trends in intracranial arteriovenous malformations (AVM) imaging utilization and interventions in US inpatient hospital stays. Using 2006-2014 data from the Nationwide Inpatient Sample (NIS), we identified inpatient stays with a primary diagnosis of intracranial AVM. Changes in the utilization of non-invasive neuroimaging (both CT and MRI), catheter-based digital subtraction angiography (DSA), and interventions (open surgical, endovascular and radiosurgery) were identified and independent predictors were evaluated using logistic regression. Between 2006 and 2014, there were a weighted total of 39,255 inpatient stays with for intracranial AVM (mean age, 40; 49% male; 59% white; 54% with private insurance). Utilization of head CT decreased from 5.2% of encounters in 2006 to 3.1% in 2014; brain MRI decreased from 7.4% to 4.1%. In contrast, DSA increased from 54.6% to 59.3% of stays. Open surgical repair increased from 27.8% to 33.6% of stays, while endovascular therapy and radiosurgery decreased from 40.2% to 33.3% and 1.0% to 0.6%, respectively. Significant independent predictors for utilization of non-invasive imaging, DSA, endovascular and surgical interventions are reported in Table 1. Over time, inpatient utilization of head CT and brain MRI in the setting of intracranial AVM has decreased, suggesting increased use of preadmission emergency department and outpatient imaging. Although endovascular treatment was the most common intervention in 2006, its use in recent years has declined as open surgery has become more frequent.Table 1Independent predictors of inpatient imaging and interventions for intracranial AVM.Imaging [OR(95% CI)]DSAEndovascularSurgeryAge ≤ 501.0 (0.8-1.3)0.9 (0.8-1.1)0.9 (0.9-1.1)1.4 (1.0-1.8)Male1.0 (0.8-1.2)1.2 (1.1-1.4)1.0 (0.9-1.2)1.1 (0.9-1.3)Elective admission0.5 (0.3-0.7)2.1 (1.7-2.7)4.5 (3.5-5.7)3.9 (3.0-5.1)Non-weekend admission0.9 (0.7-1.3)1.2 (0.9-1.5)1.9 (1.3-2.7)1.5 (1.0-2.2)Length of stay >6 days2.0 (1.5-2.7)1.8 (1.5-2.2)1.2 (0.9-1.6)6.4 (5.2-7.9) Open table in a new tab