Abstract
Cerebral arteriovenous malformations (AVMs) represent a complex neurosurgical challenge with management strategies that vary significantly across regions. The decision to treat unruptured AVMs, in particular, is controversial, with options ranging from conservative management to surgical excision or endovascular embolization. This study investigates regional variations in treating unruptured and ruptured AVMs in the United States. We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016 to 2021, identifying 34,900 unruptured AVM cases and 11,580 ruptured AVM cases in adult patients. Multivariate logistic regression models were used to determine regional predictors of undergoing open surgery, with the New England region serving as the reference group. For unruptured AVMs, 81.0% of patients underwent no intervention, 14.3% received embolization, and 3.9% underwent surgical excision. The odds of undergoing surgery were significantly lower in the Middle Atlantic (OR 0.377, CI 0.223-0.638, p<0.001), South Atlantic (OR 0.380, CI 0.224-0.643, p<0.001), and Pacific (OR 0.535, CI 0.331-0.864, p=0.0105) regions compared to New England. In contrast, for ruptured AVMs, 73.5% of patients did not receive intervention, while 16.5% received embolization, and 2.8% underwent combined treatment. The odds of undergoing surgery were significantly higher in the Middle Atlantic (OR 9.062, CI 1.147-71.61, p=0.0366), East North Central (OR 9.695, CI 1.249-75.28, p=0.0298), and Mountain (OR 8.656, CI 1.013-74.01, p=0.0487) regions compared to New England. This study reveals significant regional disparities in the management of AVMs, with patients in certain regions being significantly less or more likely to undergo surgery. These findings highlight the need for standardized treatment guidelines to ensure equitable access to appropriate care across the United States.
Published Version
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