Predictors of Extended Length of Stay after Treatment of Unruptured Intracranial Aneurysms.

ABSTRACT

BACKGROUND AND OBJECTIVES: Despite their asymptomatic occurrence, unruptured intracranial aneurysms (UIAs) account for a significant proportion of hospital charges and healthcare resource utilization in the United States. Hospital length of stay (LOS) is a reimbursement metric utilized to incentivize value-based care. Our study identifies predictors of extended LOS (eLOS) after elective treatment of UIAs. METHODS: This was a retrospective study of 525 patients who underwent elective treatment of an unruptured intracranial aneurysm (UIA) at a single institution. Data was collected with regard to demographics, clinical presentation, treatment characteristics and post-operative outcomes. The primary outcome, eLOS, was defined as hospital stay in the upper quartile of the median (≥75th percentile). Univariate and multivariate analyses was performed to identify factors predictive of eLOS in this cohort. RESULTS: The average age of the cohort was 61.40, standard deviation (SD)= 11.41. 77.3% of the cohort was female. The median duration of LOS was 2 days (interquartile range (IQR) 1-5). 11.6% experienced eLOS (≥5 days). Multivariate logistic regression identified age (OR 1.04, 95% confidence interval (CI) 1.01- 1.07), co-existent vascular pathology (OR 21.33, 95% CI 8.06- 56.39), open surgery (OR 3.93, 95% CI 1.85- 8.34) and post-operative stroke (OR 11.72, 95% CI 3.18- 43.18) as independent predictors of eLOS. CONCLUSION: Our study identified predictors of eLOS that could help promote risk stratification prior to treatment of UIAs. Future research that identifies predictors of long term outcomes based on treatment modality could help identify ways to improve healthcare resource utilization in this cohort.