Cerebral cavernous Malformation Surgery: National trends in Volume, Complications, and costs

Background and Objectives

Cerebral cavernous malformations (CCMs) are vascular anomalies that can lead to significant neurological complications, such as hemorrhage or lesion progression. This study analyzes trends in CCM resections across the United States, focusing on morbidity, mortality, and associated costs.

Methods

A retrospective analysis was conducted on the National Inpatient Sample who underwent CCM resections from 2016 to 2020. Data were collected from a national database, including patient demographics, outcomes, and costs. Statistical analysis was performed to identify factors associated with in-hospital mortality, complications, length of stay (LOS), and cost.

Results

The patient cohort identified 3,300 patients with a mean age of 42.8 years, with a slight female predominance (53.5 %) and a majority identifying as white (66.5 %). Complications occurred in 8.5 % of cases, with acute bleeding significantly increasing the risk of complications (OR = 2.15, p < 0.001), non-home discharge (OR = 2.52, p < 0.001), and extended LOS (OR = 3.21, p < 0.001). Non-elective admissions were associated with higher rates of complications (17.0 % vs. 3.4 %, p < 0.001) and extended LOS (OR = 2.84, p < 0.001). Independent factors for poor outcomes included higher Charlson Comorbidity Index (CCI) scores (OR = 1.417, p < 0.01) and patient demographics such as age and race, with Black race (OR = 6.84, p = 0.0199) and lower household income (OR = 2.17, p < 0.01) being significant predictors of in-hospital mortality.

Conclusion

This study highlights the significant impact of acute bleeding and non-elective admissions on complications and outcomes following CCM resection. Further research is warranted to analyze socio-economic factors in improving CCM resection outcomes and explore possible pharmacological treatment approaches in high-risk surgical patients.