{
  "abstract": "Background As flow diversion rapidly overtakes coiling as the dominant treatment for unruptured intracranial aneurysms nationally, comparative data on inpatient outcomes and resource utilization across all three modalities are needed to evaluate the value implications of this transition. National comparative analyses are lacking, particularly for discharge disposition.Methods We conducted a retrospective study of adult treated intracranial aneurysm hospitalizations in the National Inpatient Sample (NIS, 2016-2023). Cases were categorized into clipping, coiling/embolization, or flow diversion. Outcomes included in-hospital mortality, log-transformed length of stay (LOS), inflation-adjusted total hospital cost, and non-routine discharge (DISPUNIFORM ≠1). Survey-weighted logistic regression (mortality, discharge) and linear regression (LOS, cost) were adjusted for treatment group (clipping as reference), rupture status, age, sex, comorbidity burden, hospital characteristics, payer, income, year, and elective status. Subpopulation analyses were conducted separately for unruptured and ruptured cohorts.Results Among 18,704 admissions (weighted ≈93,520), unadjusted mean LOS was 9.2 days for clipping, 7.3 days for coiling, and 3.1 days for flow diversion; mean inflation-adjusted costs were $60,178, $55,957, and $40,557, respectively. In adjusted regression, both coiling (β = −0.528, p<0.001) and flow diversion (β = −0.534, p<0.001) were independently associated with significantly shorter LOS versus clipping. Both endovascular modalities were also associated with lower adjusted hospital costs versus clipping (coiling β = −0.111, p<0.001; flow diverter β = −0.076, p = 0.004). For discharge disposition, flow diversion demonstrated the most favorable profile: coiling (OR 0.240, 95% CI 0.207-0.277) and flow diversion (OR 0.183, 95% CI 0.141-0.239) were both associated with dramatically lower odds of non-routine discharge relative to clipping (both p<0.001). Rupture status was the strongest predictor of adverse resource outcomes: ruptured aneurysm independently predicted longer LOS (β = +0.800, p<0.001), higher costs (β = +0.504, p<0.001), and non-routine discharge (OR 3.43, p<0.001). Each calendar year was independently associated with improving discharge outcomes over time (OR 0.934 per year, p = 0.002).Conclusions Across a nationally representative cohort, both coiling and flow diversion are associated with significantly shorter stays, lower costs, and substantially lower non-routine discharge rates compared to clipping after full adjustment. Flow diversion demonstrates the most favorable discharge profile of any modality. As flow diversion continues its rapid national ascent, these findings support the economic and outcomes-related sustainability of this shift and reinforce the value of endovascular approaches in contemporary aneurysm management.Disclosures A. Elbayomy: None. S. Hassan: None. L. Mcguire: None. A. Ahmed: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "A Elbayomy"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "S Hassan"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "L Mcguire"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "A Ahmed"
    }
  ],
  "title": "E-022 Inpatient outcomes and resource utilization across clipping, coiling/embolization, and flow diversion for intracranial aneurysms: a national analysis",
  "uid": "bbe0fa5f-a4f4-571f-b75d-4dcc4526ccf5"
}