Health Care Utilization Metrics and Outcomes Relating to the Use of Intraoperative Neuromonitoring in Carotid Endarterectomy: A Nationwide Analysis.

IF 2.4 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-06-09 DOI:10.1097/ANA.0000000000001044

Ali Al-Salahat, Danielle B Dilsaver, Ali Bin Abdul Jabbar, Rohan Sharma, Yu-Ting Chen

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引用次数: 0

Abstract

Background: Intraoperative neuromonitoring (IONM) is used to detect neurological complications during carotid endarterectomy (CEA), and current data show mixed results in clinical outcomes. This study aimed to examine health care utilization metrics and outcomes relating to the use of IONM in CEA using a large national database in the USA.

Methods: Data were abstracted from the 2016 to 2021 Nationwide Readmissions Database. The primary aim was to evaluate whether adverse neurological events, hospital costs, length of stay (LOS), and routine discharge differed by the presence of IONM. We additionally evaluated whether all-cause 30-day and 90-day readmissions, and in-hospital mortality differed by IONM. We adjusted outcomes to control for age, comorbidity burden, left-sided surgery, and elective admission.

Results: There were an estimated 283,045 hospitalizations for CEA, of which 13,469 (4.79%) had IONM. IONM was associated with 12% longer adjusted stays, 16% higher adjusted costs and 35% lower odds of routine discharge ( P <0.001). In addition, IONM was associated with increased odds of an adverse neurological event, which included ischemic and hemorrhagic cerebrovascular complications (IONM: 19.40% vs. 12.65%, aOR: 1.31, 95% CI: 1.18-1.45, P <0.001). Lower income quartiles and rural/nonteaching facilities were associated with lower odds of IONM use. There were no differences in mortality or all-cause readmissions.

Conclusions: Our findings showed worse outcomes associated with IONM use during CEA. IONM is typically utilized in high-surgical-risk patients, largely accounting for our findings. The higher costs, longer hospital stays, and lower odds of routine discharge associated with IONM use need to be balanced with potential benefits. We also found significant disparities based on facility type and income. Detailed procedural risk factors, which are lacking from this data, limit the results of this study.

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颈动脉内膜切除术中使用术中神经监测的医疗保健利用指标和结果：一项全国性分析

背景：术中神经监测（IONM）用于检测颈动脉内膜切除术（CEA）期间的神经系统并发症，目前的数据显示临床结果好坏参半。本研究旨在使用美国大型国家数据库检查与CEA使用IONM相关的医疗保健利用指标和结果。方法：数据提取自2016 - 2021年全国再入院数据库。主要目的是评估不良神经事件、住院费用、住院时间（LOS）和常规出院是否因IONM的存在而有所不同。我们还评估了全因30天和90天再入院率以及住院死亡率是否因IONM而不同。我们调整了结果，以控制年龄、合并症负担、左侧手术和选择性入院。结果：估计有283,045例CEA住院，其中13,469例（4.79%）为IONM。IONM与12%的调整住院时间、16%的调整费用和35%的常规出院几率相关(结论：我们的研究结果显示，CEA期间使用IONM的结果较差。IONM通常用于手术风险高的患者，这在很大程度上解释了我们的发现。与IONM使用相关的较高的费用、较长的住院时间和较低的常规出院几率需要与潜在的益处相平衡。我们还发现了基于设施类型和收入的显著差异。这些数据中缺乏详细的程序性风险因素，限制了本研究的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.