Microsurgery for Unruptured Cerebral Arteriovenous Malformations in the National Inpatient Sample is More Common Post-ARUBA

Birnbaum, Lee; Straight, Matthew; Hegde, Sheetal; Lacci, John V.; Stanonik, Mateja de Leonni; McDougall, Cameron M.; Caron, J.

doi:10.1016/j.wneu.2020.01.211

Cited by 8 publications

(8 citation statements)

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“…Interestingly, both the studies that looked at this data came to different conclusions than the study presented here. A study by Birnbaum et al that also looked at the NIS found that though treatment rates did decrease in the post ARUBA period, and the rate of surgical intervention increased [3]. However, the authors did not seem to convert the data to nationalized estimates which may have led to the discrepancy in findings.…”

Section: Discussionmentioning

confidence: 99%

“…As of December 2020, only one study in the literature has analyzed the effect of this conclusion on national treatment patterns for unruptured AVMs (uAVM) from 2011 to 2015 using a national database [3]. Their findings suggest that ARUBA had an influence on treatment patterns, resulting in a decreased rate of intervention, but an increase in rate of microsurgery [3]. However, this study only examined changes 1 year post-ARUBA publication making it difficult to draw meaningful conclusions [15].…”

Section: This Article Is Part Of the Topical Collection On Vascular Neurosurgery -Arteriovenousmentioning

confidence: 99%

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Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study

et al. 2021

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Background In 2014, A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) concluded that medical management alone for cranial arteriovenous malformations (AVMs) had better clinical outcomes than interventional treatment. The impact of the ARUBA study on changes in the rates of intervention and outcomes is unknown. Thus, we investigated whether the conclusions from ARUBA may have influenced treatment modalities and outcomes of unruptured AVMs. Methods The National Inpatient Sample (NIS) was queried between 2006 and 2018, for adult patients with an AVM who were admitted on an elective basis. Interventions included open, endovascular, and stereotactic surgeries. Join-point regression was used to assess differences in slopes of treatment rate for each modality before and after the time-point. Logistic regression was used to assess the odds of non-routine discharge and hemorrhage between the two time-points for each treatment modality. Linear regression was used to assess the mean length of stay (LOS) for each treatment modality between the two time-points. Results A total of 40,285 elective admissions for AVMs were identified between 2006 and 2018. The rate of intervention was higher pre-ARUBA (n = 15,848; 63.8%) compared to post-ARUBA (n = 6985; 45.2%; difference in slope − 8.24%, p < 0.001). The rate of open surgery decreased, while endovascular and stereotactic surgeries remained the same, after the ARUBA trial time-point (difference in slopes − 8.24%, p < 0.001; − 1.74%, p = 0.055; 0.20%, p = 0.22, respectively). For admissions involving interventions, the odds of non-routine discharge were higher post-ARUBA (OR 1.24; p = 0.043); the odds of hemorrhage were lower post-ARUBA (OR 0.69; p = 0.025). There was no statistical difference in length of stay between the two time-points (p = 0.22). ConclusionThe rate of intervention decreased, the rate of non-routine discharge increased, and rate of hemorrhage decreased post-ARUBA, suggesting that it may have influenced treatment practices for unruptured AVMs.

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Section: Discussionmentioning

confidence: 99%

Section: This Article Is Part Of the Topical Collection On Vascular Neurosurgery -Arteriovenousmentioning

confidence: 99%

Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study

et al. 2021

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“…To date, two scientific analyses dissect the issue of the impact of the ARUBA trial on clinical practice, in particular in the USA [1,11]. Birnbaum and colleagues queried the Nationwide Inpatient Sample (NIS) database up to the end of 2015.…”

mentioning

confidence: 99%

“…It is the largest public national all-payer database and is sponsored by the Agency for Healthcare Research and Quality (AHRQ). Birnbaum et al [1] came to the conclusion that even though the number of treated unruptured bAVMs seemed to decrease, the rate of microsurgically treated bAVMs increased.…”

mentioning

confidence: 99%

“…The new analysis uses a combination of ICD-9 and ICD-10 codes, while the previous two publications used ICD-9 codes. In terms of analysis, Birnbaum et al [1] used simple inference tests, whereas Reynolds et al and Wahood et al used join-point regression to make sense of the (to a certain extent autocorrelated) time series data. None of the papers used adjustment for multiple correction or propensity-adjusted regression discontinuity analysis, for example.…”

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confidence: 99%

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The impact of ARUBA on the clinical practice of unruptured brain arteriovenous malformations: big data, poor evidence and measuring impact on health policy

Volovici

Meling

2021

Acta Neurochir

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Impact of ARUBA trial on trends and outcomes in symptomatic non-ruptured brain AVMs: A national sample analysis

Patel¹,

Saber²,

Desai³

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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Microsurgery for Unruptured Cerebral Arteriovenous Malformations in the National Inpatient Sample is More Common Post-ARUBA

Cited by 8 publications

References 11 publications

Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study

Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study

The impact of ARUBA on the clinical practice of unruptured brain arteriovenous malformations: big data, poor evidence and measuring impact on health policy

Impact of ARUBA trial on trends and outcomes in symptomatic non-ruptured brain AVMs: A national sample analysis

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