Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups

Matthew J McPheeters; Muhammad Waqas; Jaims Lim; Kyungduk Rho; Vinay Jaikumar; Andrew Gong; Kunal P Raygor; Steven B Housley; Tyler A Scullen; Mehdi Bouslama; Elad I Levy

doi:10.1227/neu.0000000000003295

Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups

Neurosurgery. 2024 Dec 3. doi: 10.1227/neu.0000000000003295. Online ahead of print.

Authors

Matthew J McPheeters^{1

2}, Muhammad Waqas^{1

2}, Jaims Lim^{1

2}, Kyungduk Rho^{1

2}, Vinay Jaikumar^{1

2}, Andrew Gong^{2

3}, Kunal P Raygor^{1

2}, Steven B Housley^{1

2}, Tyler A Scullen^{1

2}, Mehdi Bouslama^{1

2}, Elad I Levy^{1

2

4

5

6}

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
² Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
³ Current Affiliation: Inova Neurosurgical Residency Program, Fairfax, Virginia, USA.
⁴ Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁵ Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.
⁶ Jacobs Institute, Buffalo, New York, USA.

PMID: 39625279
DOI: 10.1227/neu.0000000000003295

Abstract

Background and objectives: The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies.

Methods: We performed a retrospective analysis on the data of healthy (Charlson Comorbidity Index ≤4) adult patients undergoing elective neurosurgical procedures including endovascular repair of UIAs, ACDF, and discectomy between January 1, 2012, and August 31, 2019, at a single tertiary facility. Clinical complications and outcomes data were collected and analyzed. The primary outcome variable was the 30-day readmission rate with subgroup analyses of readmission <48 hours and 48 hours to 30 days.

Results: A total of 586 patients and a total of 606 procedures were identified, comprising 205 endovascular UIA treatments, 201 ACDFs, and 200 discectomies. Fourteen UIA procedures were excluded from analysis (n = 191) on the basis of anatomic high-risk features. For the primary outcome, there was no statistically significant difference in 30-day readmission rates among the comparison groups (P = .36). For the subgroup analyses, there were no differences in readmission rates for <48 hours (P = .06) and 48 hours to 30 days (P = .71). In addition, there was no significant difference in intraprocedural complication rates among the groups (P = .19).

Conclusion: Inpatient elective endovascular treatment of UIAs had similarly low rates of intraprocedural complications and short-term readmissions compared with the established outpatient spine procedures. We hope that our findings may serve as the foundation for future, prospective studies assessing the safety and utility of performing endovascular procedures for UIAs in an outpatient setting.