Predictors of a Nonroutine Discharge After Surgical Treatment of an Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study.

BACKGROUND

Nonroutine discharge (NRD), postoperative discharge to settings other than home, is an understudied quality metric vital to value-based health care systems. This study identified predictors of NRD after surgical treatment of unruptured intracranial aneurysms (UIAs).

METHODS

Demographic and clinical characteristics were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients with microsurgical treatment of UIAs from 2016 through 2020. The primary outcome was NRD. Propensity score matching and multivariable logistic regression were used to identify independent risk factors.

RESULTS

Data from 929 patients were analyzed. NRD occurred in 158 (17%) of the patients. Factors associated with increased odds of NRD included age ≥65 years (odds ratio [OR] = 2.25), female sex (OR = 1.83), American Society of Anesthesiologists class≥III (OR = 2.07), diabetes mellitus (OR = 2.15), length of stay (LOS) ≥7 days (OR = 8.19), postoperative deep vein thrombosis (OR = 8.69), postoperative pneumonia (OR 5.89), and postoperative stroke (OR 6.98). Patients with vertebrobasilar UIAs had longer LOS than those with carotid UIAs (8.3 [8.9] vs. 6.2 [5.5] days; P = 0.03). Compared with simple UIAs, complex UIAs were associated with longer operative times (283 [116.9] vs. 228 [94.6] minutes; P < 0.001), longer LOS (6.0 [6.4] vs. 4.8 [4.0] days; P = 0.002), higher rates of postoperative stroke (8% vs. 4%; P = 0.01), and higher NRD rates (20% vs. 12%; P = 0.003).

CONCLUSIONS

Demographic and perioperative factors were independently associated with NRD after UIA microsurgery. Identifying these predictors can improve risk stratification, optimize care pathways, and inform policies to enhance outcomes and reduce health care costs.