Abstract
Background: Data regarding national estimates of brain arteriovenous malformation (BAVM) among adults in United States data are scant, often biased by limitations of single center and regional studies. Identification of such patients in nationally representative datasets was not possible until recently due to a new specific ICD-10 code. Objective: To characterize inpatient burden, expenditures, associated comorbidities (including intracerebral hemorrhages and seizures) and treatments of BAVM among adults in United States. Methods: Patients with BAVM were identified from the Nationwide Inpatient Sample (NIS) database for the year 2016 using ICD-10 diagnostic code (Q28.2). The primary outcome was to determine the prevalence of BAVM in the adult (18 and above) in-patient population in the United States. Secondary outcomes included determining inpatient mortality, morbidity, comorbidities, hospital length of stay (LOS) and total hospital charges. Outcome was classified by discharge disposition into none to minimal and moderate to severe disability. Results: Of the total 7,135,090 reported hospital discharges in 2016, an estimated 1733 (0.02%) had the diagnosis of BAVM; 1547 were adults with ages 18 or greater (mean age [SD] 54 (18); 783 (50.6%) were men). Patients with BAVM were whites (n= 921, 59.5%), African-Americans (n=224, 14.4%) and Hispanic (n=212, 13.7%). Underlying hypertension was identified in 677 (43.1%) patients. Clinical presentation was intracerebral hemorrhage (n=260, 16.8%), seizures (n=234, 15.1%) and subarachnoid hemorrhage (n=75, 4.8%). Endovascular treatment was performed in 272 (17.5%) patients and surgical treatment was performed in 45 (2.9%) patients. None to minimal disability was seen in 1023 (66.1%) and moderate to severe disability was seen in 469 (30.3%) of the patients. In hospital mortality was 2.59% (n=40). Average LOS (SD) was 4 days (8.6) with mean hospitalization charges (SD) of $121,186 (153553.1). Conclusion: There are 1547 hospital admissions for BAVM among adults in United States every year. The overall outcomes were good with high rates of none to minimal disability but the hospitalization charges were higher than expected and may be important for resource allocation.
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