30-day home time as a patient-centered outcome after treatment of unruptured intracranial aneurysms

BACKGROUND: Existing outcome measures after elective unruptured intracranial aneurysm (UIA) treatment predominantly assess technical or functional outcomes, which do not reflect the patient recovery experience. We evaluated 30-day home time (DAH30) as a novel patient-centered outcome metric after elective UIA treatment. METHODS: We conducted a retrospective cohort study at a tertiary neurovascular center in Melbourne, Australia, including adults undergoing elective UIA treatment between July 2010 and June 2024. DAH30 was defined as the number of days at home within 30 days after treatment, subtracting inpatient, rehabilitation, and unplanned readmission days. Analyses were conducted per procedure and compared by treatment modality (surgical and endovascular). Quantile regression assessed associations between DAH30 and demographic, clinical, and procedural factors. RESULTS: Among 530 patients undergoing 614 UIA treatments (76% female; median age 58 years, IQR 50-66), most aneurysms (80%) were in the anterior circulation, with a median size of 6 mm (IQR 4-8). Median DAH30 was 27 days (IQR 25-28). New neurological deficits lasting >24 hours were associated with 4 fewer days at home (95% CI -6.0 to -2.1, P<0.001). Compared with endovascular treatment, surgical treatment was associated with 2 fewer days at home (95% CI -2.4 to -1.7, P<0.001). In multivariable analysis, greater frailty (P=0.04), older age per decade (P=0.02), longer procedure duration (P<0.001), and surgical treatment (P<0.001) were associated with reduced DAH30. CONCLUSIONS: DAH30 is a simple and objective patient-centered outcome metric after elective UIA treatment. Following multicenter validation, DAH30 could be incorporated into quality-of-care registries and considered as an endpoint in comparative effectiveness studies of UIA treatment.