Treatment course and outcomes after revascularization surgery for moyamoya disease in adults.

Abstract

International trials suggest benefit of revascularization surgery (RS) for moyamoya disease (MMD). However, nationally representative US data on demographics and outcomes after RS in MMD are lacking. To estimate causes and rates of readmission after RS for MMD. In the Nationwide Readmissions Database, index admissions for ECICB for MMD and readmissions for ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH) were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We summarized demographics and comorbidities, and calculated 30-, 60-, and 90-day readmission rates per 100,000 index admissions. Among 201 index admissions for RS for MMD, mean age (SD) was 41.7 (12.6) years; 75% were female; 24% had diabetes; 53% had hypertension; 40% had hypercholesterolemia; 3% had ICH; 16% had IS; and 1% had SAH. RS was performed at large hospitals in 83%, urban hospitals in 85%, and teaching hospitals in 97%. 80% were discharged home. 34% had a readmission during follow-up. Leading reasons for readmission up to 90days included MMD (62%), postoperative infection (10%), sickle cell crisis (4%), ischemic stroke (4%), epilepsy (2%), subdural hemorrhage (2%) and headache (2%). Readmission rates (per 100,000 index admissions) were 559 at 30days, 1829 at 60days, and 2027 at 90days for IS. There were no readmissions for SAH or ICH. This analysis of nationally representative US data suggests that although readmission after RS for MMD is not uncommon, cerebral hemorrhagic events during the 90-day postoperative period are rare.