{
  "abstract": "Introduction/Purpose Rates of coiling in flow diversion (FD) vary from 33-72% across studies, depending on aneurysm morphology. The National Inpatient Sample (NIS) is the largest all-payer database of inpatient discharges in the United States, which systematically samples 20% of discharges from 20% of participating hospitals to estimate national rates of various outcomes. Here, we report national rates of coiling in FD using the NIS and differences in patient demographics, hospital characteristics, and patient outcomes in ruptured and unruptured aneurysms.Materials and Methods Data relevant to the endovascular treatment of cerebral aneurysms from 2020 to 2022 were extracted from the NIS database. Patients were stratified as FD or FD with coiling, based on relevant CPT codes, and patient outcomes were determined using ICD-10 codes. Univariate analysis was used to compare design-based population estimates of demographics, hospital characteristics, and patient outcomes between FD and FD with coiling, using t-tests or nonparametric equivalents.Results From 2020-2022, 7,600 patients received FD—7,380 (97.1%) with FD alone and 220 (2.89%) with FD and coiling. Mean age was 68.4 ± 14.5, 54% of patients were female, and 1,935 (25.5%) of patients had ruptured aneurysms. Patients undergoing FD with coiling were younger (p < 0.001) and less likely to be insured by Medicare (p = 0.004) but had no difference in race (p = 0.086), sex (p = 0.5), income quartile (p = 0.4), or residence type (p = 0.2). There were no differences in hospital region, teaching status, or bed size between patients undergoing FD and those with FD and coiling. Higher rates of intracerebral hemorrhage (p < 0.001), hydrocephalus (p < 0.001), and pulmonary embolism (p < 0.015) were observed in patients undergoing FD with coiling. In patients undergoing FD with coiling, length of stay (p < 0.001) and total cost of stay (p < 0.001) were significantly higher. Subgroup analysis revealed that only ruptured aneurysms showed a significant difference in Medicare payer status between FD and FD with coiling (p < 0.001). Additionally, significantly increased intracerebral hemorrhage and pulmonary embolism in FD with coiling were only observed in unruptured aneurysms (p = 0.005).Conclusion Coiling is infrequent among patients undergoing FD and is more common among younger patients with worse outcomes, likely a reflection of use in higher-risk aneurysms. Future studies should investigate insurance authorization rates for coiling with flow diversion in unruptured aneurysms, given differences in payer status and increased cost of stay.Disclosures H. Hutchinson: None. C. Dugue: None. K. Gupta: None. A. Sutar: None. C. Rawson: None. M. Pahlevani: None. M. Karsy: None. B. Lucke-Wold: None.Abstract P-026 Table 1Selected patient characteristics reported as mean (standard deviation) or n (%)",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Florida, Gainesville, FL"
      ],
      "name": "H Hutchinson"
    },
    {
      "affiliations": [
        "School of Medicine, Wayne State University, Detroit, MI"
      ],
      "name": "C Dugue"
    },
    {
      "affiliations": [
        "Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Govt Medical College, Chhattisgarh, India"
      ],
      "name": "K Gupta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan, Ann Arbor, MI"
      ],
      "name": "A Sutar"
    },
    {
      "affiliations": [
        "Noorda College of Osteopathic Medicine, Provo, UT"
      ],
      "name": "C Rawson"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monoica, CA"
      ],
      "name": "M Pahlevani"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan, Ann Arbor, MI"
      ],
      "name": "M Karsy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Florida, Gainesville, FL"
      ],
      "name": "B Lucke-Wold"
    }
  ],
  "title": "P-026 Trends and cost analysis of coiling in flow diversion using the national inpatient sample",
  "uid": "cf1e5bff-c5a6-5a6b-8a1a-736d00cb09b8"
}