1366 Can Endovascular Repair of Unruptured Intracranial Aneurysms be Safely Performed in an Ambulatory Setting? Retrospective Cohort Comparison of Short-Term Outcomes With Neurosurgical Ambulatory Control Groups

INTRODUCTION: The performance of select neurosurgical procedures is being transitioned to an ambulatory setting rather than an inpatient setting in order to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIA), the procedures are solely performed in an inpatient setting. METHODS: We performed a retrospective analysis on the data of healthy (Charlson Comorbidity index =4) adult patients undergoing elective neurosurgical procedures including endovascular repair of UIAs, ACDF, and discectomy between January 1, 2012 and August 31, 2019 at a single tertiary facility. Clinical complications and outcomes data were collected and analyzed. The primary outcome variable was the 30-day readmission rate with subgroup analyses of readmission <48 hours and 48 hours to 30 days. RESULTS: A total of 593 patients and a total of 594 procedures were identified, comprised of 193 endovascular UIA treatments, 201 ACDFs, and 200 discectomies. For the primary outcome, there was no difference in 30-day readmission rates among the comparison groups (p=0.54), and there was no difference in readmission rates for <48 hours (p=0.16) and 48 hours to 30 days (p=0.71). Additionally, there was no significant difference in the rate of intraprocedural complication between the groups (p=0.2). CONCLUSIONS: Elective endovascular treatment of UIAs had a similarly low rate of intraprocedural complications and favorable short-term outcomes compared to the established ambulatory procedures. We hope our findings may serve as the foundation for prospective larger studies assessing the safety and utility of performing ambulatory endovascular procedures for UIAs.