ICU stay may be unnecessary after elective endovascular aneurysm treatment

SAN DIEGO – In a retrospective review of almost 700 patients who underwent elective endovascular aneurysm treatment, 4% experienced postoperative complications, mostly within the first 4 hours post procedure. Almost half of the complications were groin hematomas or retroperitoneal hematomas that extended the length of inpatient stay but required no further treatment. The results suggest that patients undergoing endovascular aneurysm treatment may be transferred to a less resource-intensive environment once they have been followed closely for 4 hours, according to Bhuvic Patel, who presented the findings at the annual meeting of the American Society of Neuroradiology.

The 687 patients had unruptured intracranial aneurysms and underwent elective endovascular treatment from March 2002 to June 2012. Most patients underwent coiling alone (329) or stent-assisted coiling (242), although other patients underwent balloon-assisted coiling, Onyx HD 500 occlusion, or treatment with a pipeline embolization device with or without coiling. Nine patients experienced a complication during the procedure and were excluded from further analysis. After the procedure, patients were monitored for at least 24 hours in a neurologic intensive care unit or postanesthesia care unit.

In total, 4% had postprocedural complications (27/678). These included three intracerebral hemorrhages, six ischemic strokes, four cardiac events, five retroperitoneal hematomas, and nine groin hematomas.

Looking at the timing of the complications, 74% were detected within the first 4 hours following the procedure. These included one hemorrhage, four ischemic strokes, all four of the cardiac events, all nine of the hematomas, and two retroperitoneal hematomas.

"As you get further away from the procedures, fewer events were detected," said Mr. Patel, who is currently a medical student at the Washington University School of Medicine, St. Louis. Four complications (14.8%) were noted between 4 and 12 hours post procedure, one (3.7%) between 12 and 24 hours, and two (7.4%) more than 24 hours post procedure.

Of the two hemorrhages that were discovered 4 hours or more post procedure, both were diagnosed by head CT after patients complained of headache and neither resulted in any permanent significant deficit. For two patients who had ischemic stroke detected by MRI after 4 hours, deficits were considered minor although one patient was discharged to a skilled nursing facility.

"The complications that were detected more than 4 hours post procedure could all have been managed in a floor setting. We think it is reasonable for patients to be monitored in a postoperative intensive care setting for the first 4 hours following routine endovascular aneurysm treatment and then be transferred to be floor bed. This can translate to a lot of cost savings," says Mr. Patel.

Dr. Patel has no relevant financial disclosures.

SAN DIEGO – In a retrospective review of almost 700 patients who underwent elective endovascular aneurysm treatment, 4% experienced postoperative complications, mostly within the first 4 hours post procedure. Almost half of the complications were groin hematomas or retroperitoneal hematomas that extended the length of inpatient stay but required no further treatment. The results suggest that patients undergoing endovascular aneurysm treatment may be transferred to a less resource-intensive environment once they have been followed closely for 4 hours, according to Bhuvic Patel, who presented the findings at the annual meeting of the American Society of Neuroradiology.

The 687 patients had unruptured intracranial aneurysms and underwent elective endovascular treatment from March 2002 to June 2012. Most patients underwent coiling alone (329) or stent-assisted coiling (242), although other patients underwent balloon-assisted coiling, Onyx HD 500 occlusion, or treatment with a pipeline embolization device with or without coiling. Nine patients experienced a complication during the procedure and were excluded from further analysis. After the procedure, patients were monitored for at least 24 hours in a neurologic intensive care unit or postanesthesia care unit.

In total, 4% had postprocedural complications (27/678). These included three intracerebral hemorrhages, six ischemic strokes, four cardiac events, five retroperitoneal hematomas, and nine groin hematomas.

Looking at the timing of the complications, 74% were detected within the first 4 hours following the procedure. These included one hemorrhage, four ischemic strokes, all four of the cardiac events, all nine of the hematomas, and two retroperitoneal hematomas.

"As you get further away from the procedures, fewer events were detected," said Mr. Patel, who is currently a medical student at the Washington University School of Medicine, St. Louis. Four complications (14.8%) were noted between 4 and 12 hours post procedure, one (3.7%) between 12 and 24 hours, and two (7.4%) more than 24 hours post procedure.

Of the two hemorrhages that were discovered 4 hours or more post procedure, both were diagnosed by head CT after patients complained of headache and neither resulted in any permanent significant deficit. For two patients who had ischemic stroke detected by MRI after 4 hours, deficits were considered minor although one patient was discharged to a skilled nursing facility.

"The complications that were detected more than 4 hours post procedure could all have been managed in a floor setting. We think it is reasonable for patients to be monitored in a postoperative intensive care setting for the first 4 hours following routine endovascular aneurysm treatment and then be transferred to be floor bed. This can translate to a lot of cost savings," says Mr. Patel.

Dr. Patel has no relevant financial disclosures.

SAN DIEGO – In a retrospective review of almost 700 patients who underwent elective endovascular aneurysm treatment, 4% experienced postoperative complications, mostly within the first 4 hours post procedure. Almost half of the complications were groin hematomas or retroperitoneal hematomas that extended the length of inpatient stay but required no further treatment. The results suggest that patients undergoing endovascular aneurysm treatment may be transferred to a less resource-intensive environment once they have been followed closely for 4 hours, according to Bhuvic Patel, who presented the findings at the annual meeting of the American Society of Neuroradiology.

The 687 patients had unruptured intracranial aneurysms and underwent elective endovascular treatment from March 2002 to June 2012. Most patients underwent coiling alone (329) or stent-assisted coiling (242), although other patients underwent balloon-assisted coiling, Onyx HD 500 occlusion, or treatment with a pipeline embolization device with or without coiling. Nine patients experienced a complication during the procedure and were excluded from further analysis. After the procedure, patients were monitored for at least 24 hours in a neurologic intensive care unit or postanesthesia care unit.

In total, 4% had postprocedural complications (27/678). These included three intracerebral hemorrhages, six ischemic strokes, four cardiac events, five retroperitoneal hematomas, and nine groin hematomas.

Looking at the timing of the complications, 74% were detected within the first 4 hours following the procedure. These included one hemorrhage, four ischemic strokes, all four of the cardiac events, all nine of the hematomas, and two retroperitoneal hematomas.

"As you get further away from the procedures, fewer events were detected," said Mr. Patel, who is currently a medical student at the Washington University School of Medicine, St. Louis. Four complications (14.8%) were noted between 4 and 12 hours post procedure, one (3.7%) between 12 and 24 hours, and two (7.4%) more than 24 hours post procedure.

Of the two hemorrhages that were discovered 4 hours or more post procedure, both were diagnosed by head CT after patients complained of headache and neither resulted in any permanent significant deficit. For two patients who had ischemic stroke detected by MRI after 4 hours, deficits were considered minor although one patient was discharged to a skilled nursing facility.

"The complications that were detected more than 4 hours post procedure could all have been managed in a floor setting. We think it is reasonable for patients to be monitored in a postoperative intensive care setting for the first 4 hours following routine endovascular aneurysm treatment and then be transferred to be floor bed. This can translate to a lot of cost savings," says Mr. Patel.

Dr. Patel has no relevant financial disclosures.