Early Treatment of Ruptured Cerebral Arteriovenous Malformations: Analysis of Neurological Outcomes and Health Care Costs.
Neurosurgery
; 94(1): 212-216, 2024 01 01.
Article
em En
| MEDLINE
| ID: mdl-37665224
ABSTRACT
BACKGROUND:
The timing of surgical resection is controversial when managing ruptured arteriovenous malformations (AVMs) and varies considerably among centers.OBJECTIVE:
To retrospectively analyze clinical outcomes and hospital costs associated with delayed treatment in a ruptured cerebral AVM patient cohort.METHODS:
Patients undergoing surgical treatment for a ruptured cerebral AVM (January 1, 2015-December 31, 2020) were retrospectively analyzed. Patients who underwent emergent treatment of a ruptured AVM because of acute herniation were excluded, as were those treated >180 days after rupture. Patients were stratified by the timing of surgical intervention relative to AVM rupture into early (postbleed days 1-20) and delayed (postbleed days 21-180) treatment cohorts.RESULTS:
Eighty-seven patients were identified. The early treatment cohort comprised 75 (86%) patients. The mean (SD) length of time between AVM rupture and surgical resection was 5 (5) days in the early cohort and 73 (60) days in the delayed cohort ( P < .001). The cohorts did not differ with respect to patient demographics, AVM size, Spetzler-Martin grade, frequency of preoperative embolization, or severity of clinical presentation ( P ≥ .15). Follow-up neurological status was equivalent between the cohorts ( P = .65). The associated mean health care costs were higher in the delayed treatment cohort ($241 597 [$99 363]) than in the early treatment cohort ($133 989 [$110 947]) ( P = .02). After adjustment for length of stay, each day of delayed treatment increased cost by a mean of $2465 (95% CI = $967-$3964, P = .002).CONCLUSION:
Early treatment of ruptured AVMs was associated with significantly lower health care costs than delayed treatment, but surgical and neurological outcomes were equivalent.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Malformações Arteriovenosas Intracranianas
/
Radiocirurgia
/
Embolização Terapêutica
Tipo de estudo:
Health_economic_evaluation
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article