Reduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study.

摘要: Introduction The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation follow-up outcomes costs remains to be completed. Methods Premier Healthcare Database (PHD), 2010–2017, was queried identify patients with unruptured aneurysms treated endovascularly. Rates readmission, retreatment, cost at same hospital were compared between who underwent PED non-PED treatments their One-to-three (PED–to–non-PED) propensity score (PS) matching performed adjust for potential case selection bias into cohort, covariates age group, sex, Charlson Comorbidity Index (CCI) payor, region, randomized identifier. Results A total 679 placement 8432 had treatments. Prior PS matching, there significant but minor differences (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) sex (male 16.6% 24.4%, p<0.0001) non-PED, respectively, no CCI (p 0.08), length stay 0.88), or rate routine discharge 0.21). All-cause readmission/emergency department reevaluation rates two cohorts similar 30, 90, 180 days 1 2 years. Our results identified significantly lower retreatment PEDs all time points over 2-year period (range: 0.9–8.1%) 1.7–11.6%). These findings remained consistent after matching: all-cause readmission/reevaluation 90 days, year, years (p<0.001). Although initial higher (p<0.001), cumulative emergency visit readmission (inclusive and/or retreatment) relative 0.021). Conclusions suggest that may potentially reduce downstream costs. Further work is required improve identification patient subgroups could benefit from both initially during follow-up.