ObjectiveMultiple studies suggest routine post-operative intensive care unit (ICU) stays after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) is unnecessary, though rates of ICU utilization nationwide are unknown. We aim to evaluate rates and characteristics of ICU utilization in patients undergoing elective endovascular repair of UIAs.MethodsThis is a retrospective cohort study utilizing a nationwide private-payer database in the United States to evaluate the ICU utilization in patients undergoing elective endovascular repair of UIAs between 2005 and 2019. Demographics and pre-operative comorbidities as well as post-procedural complications and discharge status were compared. An analysis of charges and costs was also performed.ResultsAmong 6218 patients who underwent elective EVT of a UIA, 4890 (78.6%) were admitted to the ICU post-operatively. There were no differences in age, sex, or Charlson comorbidity scores in patients admitted to the ICU post-operatively compared to those admitted elsewhere. ICU utilization was more common in urban locations compared to rural. 12.7% of patients had ICU-specific needs sufficient to be billed by a critical care provider. Total provider costs were significantly higher in patients utilizing the ICU post-operatively, even among uncomplicated patients with routine discharges.ConclusionMost patients undergoing elective endovascular UIA repair in the United States are admitted to the ICU postoperatively. Only 12.7% have ICU needs, and these patients are predictable from pre-operative characteristics or peri-operative complications. Reducing ICU use in this subgroup of patients may be an important target to improve healthcare value in this patient population.

中文翻译：

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未破裂颅内动脉瘤择期血管内治疗中重症监护病房利用率的全国趋势

目的 多项研究表明，未破裂颅内动脉瘤 (UIA) 进行血管内治疗 (EVT) 后，常规术后入住重症监护病房 (ICU) 是不必要的，尽管全国 ICU 利用率尚不清楚。我们的目的是评估接受选择性 UIA 血管内修复术的患者的 ICU 使用率和特征。方法这是一项回顾性队列研究，利用美国全国范围内的私人支付者数据库来评估接受选择性 UIA 血管内修复术的患者的 ICU 使用率2005 年和 2019 年。比较了人口统计数据和术前合并症以及术后并发症和出院状况。还对收费和成本进行了分析。结果在 6218 例接受 UIA 选择性 EVT 的患者中，4890 例 (78.6%) 术后入住 ICU。术后入住 ICU 的患者与其他地方入住的患者相比，年龄、性别或查尔森合并症评分没有差异。与农村相比，城市地区的 ICU 使用率更高。12.7% 的患者有 ICU 特定需求，足以由重症监护提供者支付费用。术后使用 ICU 的患者的总医疗费用显着较高，即使是常规出院的无并发症患者也是如此。 结论 在美国，大多数接受选择性血管内 UIA 修复术的患者术后都会住进 ICU。只有 12.7% 需要 ICU，这些患者可以根据术前特征或围手术期并发症进行预测。减少该亚组患者的 ICU 使用可能是提高该患者群体医疗保健价值的重要目标。