• Neurosurgery · Jan 2024

    Early Treatment of Ruptured Cerebral Arteriovenous Malformations: Analysis of Neurological Outcomes and Health Care Costs.

    • Jacob F Baranoski, Stefan W Koester, Joshua S Catapano, Joseph H Garcia, Mark A Pacult, Brandon K Hoglund, Stephen J Dabrowski, Dimitri Benner, Ethan A Winkler, Tyler S Cole, Caleb Rutledge, Visish M Srinivasan, Christopher S Graffeo, Andrew F Ducruet, Felipe C Albuquerque, and Michael T Lawton.
    • Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA.
    • Neurosurgery. 2024 Jan 1; 94 (1): 212216212-216.

    BackgroundThe timing of surgical resection is controversial when managing ruptured arteriovenous malformations (AVMs) and varies considerably among centers.ObjectiveTo retrospectively analyze clinical outcomes and hospital costs associated with delayed treatment in a ruptured cerebral AVM patient cohort.MethodsPatients 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.ResultsEighty-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).ConclusionEarly treatment of ruptured AVMs was associated with significantly lower health care costs than delayed treatment, but surgical and neurological outcomes were equivalent.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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