Abstract WP86: Treatment Patterns and Outcomes for Ruptured and Unruptured Intracranial Aneurysms in Patients With Polycystic Kidney Disease

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Abstract

Background: Patients with polycystic kidney disease (PKD) have a high incidence of intracranial aneurysms. Patterns of surgical and endovascular treatments and their associated outcomes are largely unknown in this patient population.

Methods: We used the National Inpatient Sample (NIS, years 2002-2012) to compare the in-hospital outcomes of aneurysm treatments between PKD and non PKD patients. In our cohort, we included all adult patients (18 years or older) with the primary discharge diagnoses of ruptured and unruptured aneurysms with or without a secondary diagnosis of PKD. We analyzed the following comparative outcomes of PKD patients: 1) rates of endovascular and surgical treatments; 2) in-hospital complications; 3) length of hospital stay; 4) moderate-to severe-disability; and 5) mortality.

Results: Of all the admitted patients (n=182,012) for aneurysmal treatment, 1105 (0.61%) patients had PKD. Rates of surgical treatment were higher in the PKD cohort (64.23 % versus 51.63 %, p= 0.0008) while fewer of the PKD patients underwent endovascular treatment (35.7 % versus 48.3 %, p= 0.0008). Lower rates of in-hospital complications such as: myocardial infarction, pneumonia, deep venous thrombosis, hyponatremia, cerebral vasospasm, hydrocephalus, were seen in the PKD group PKD patients were also less likely to receive intubation, mechanical ventilation, ventriculostomy, gastrostomy and ventriculoperitoneal shunt as compared to patients with no PKD. There was no significant difference in the mean length of hospital stay (9.4 versus 10.7 days, p=0.0873) between the two groups. Mean hospital charges in the US dollars (118209 versus 140003, p=0.0179) were also lower in the PKD group. Rates of moderate-to-severe disability and in-hospital mortality were also significantly lower in the PKD cohort- 17.2 % versus 23.2 %; P= 0.0442 and 3.5% versus 6.3%; P=0.0276 respectively.

Conclusions: In patients admitted for treatment of ruptured or unruptured intracranial aneurysms, PKD status is associated with significantly lower rates of certain in-hospital complications, moderate-to-severe disability and mortality in comparison with non-PKD patients.

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