Medical Student University of Miami Miller School of Medicine Miami, Florida, United States
Introduction: There has been a recent decrease in the interventional management of cerebral arteriovenous malformations (AVMs) due to studies indicating the superiority of medical management for unruptured AVMs. The objective of our study is to evaluate the changing patterns in management and subsequent outcomes for AVMs in the first year of the COVID-19 pandemic.
Methods: The National Inpatient Sample (NIS) database was used, which is designed to provide nationwide estimates. Patients from the years 2016-2020 with an ICD-10 diagnosis code for a cerebral AVM were included. An intervention was defined as ICD-10 code for either surgical, endovascular, or stereotactic radiosurgery treatment of a cerebral AVM. Odds ratios (OR) were calculated using a logistic regression model with age, sex, presence of cerebral aneurysms, insurance type, hospital teaching status, hospital bed size, race, and weighted Elixhauser comorbidity score as covariates.
Results: A total of 63,610 patients with AVMs were identified between 2016-2020, with 14,340 ruptured. Patients in the year 2020 had an odds ratio (OR) of 0.69 (95% CI: 0.65, 0.74), for the intervention of an unruptured AVM, p< 0.0001, compared to 2016-2019. Ruptured AVMs had an OR of 0.81 (0.73, 0.89), for intervention, p< 0.0001. The rate of intervention for unruptured AVMs decreased to 13.5% (12.6%, 14.0%) in 2020 from 17.6% (17.2%, 17.9%) in 2016-2019, p< 0.0001. The rate of AVM rupture in 2020 increased to 23.9% (23.2%, 24.7%) from 22.2% (21.8%, 22.6%) in 2016-2019, p< 0.0001. Linear regression analysis from 2016-2020 showed an inverse relationship between intervention rate and rupture rate, with a slope of -0.499, R-squared of 0.88, and p=0.019.
Conclusion : During 2020, the rate of intervention for unruptured cerebral decreased prior to past years with an associated increase in the rate of rupture. This suggests there should be further investigation into the optimal type of management, medical or interventional, for cerebral AVMs.
