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Abstract
Background In 2014, A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) concluded that medical management alone for cranial arteriovenous malformations (AVMs) had better clinical outcomes than interventional treatment. A significant decrease followed this finding in the rate of open AVM resection compared to endovascular treatment. The ARUBA study’s impact on changes in intervention and outcomes rates is unknown. Thus, we investigated whether the conclusions from ARUBA may have influenced the outcomes following the open resection of unruptured AVMs.
Methods The National Surgical Quality Improvement Program (NSQIP) was queried between 2010 and 2020 for adult patients who underwent open resection of unruptured AVMs. Logistic regression was used to assess the odds of postoperative rupture, upper quartile (Q3) of LOS (≥12 days), and operative time (≥327) following open resection of AVMs. Join-point regression was used to assess differences in outcomes of the following resection before and after the time-point (2014).
Results A total of 760 patients underwent open resection of AVMs between 2010 and 2020, with 20% ruptured (N=152). The postoperative Q3 LOS, operative time, and postoperative AVM rupture rates decreased between 2010 and 2020 (p<0.01). Comparing pre and post-ARUBA periods, we found that the pre-ARUBA period (OR= 1.71, p=0.03), transfer from non-home (OR= 2.79, p<0.01), and ventilation for > 48 hours (OR= 2.6, p=0.02) are more likely to increase the risk of AVM rupture following resection. Age (OR= 1.03, p<0.01), Higher preoperative WBC (OR= 1.1, p<0.01), platelet count (OR= 1.003, p=0.02) and ventilation for > 48 hs (OR= 5.57, p<0.01) are more likely to increase the risk of extended LOS following resection while smoking is more likely to increase the risk of Q3 operative time (OR= 1.49, p<0.01). For the post-ARUBA period, preoperative INR (OR= 15.64, p<0.01), partially independent functional status (OR= 5.31, p<0.01), and ventilation for > 48 hours (OR= 2.47, p=0.01) are more likely to increase the risk of postoperative AVM rupture; Age(OR= 1.03, p=0.01) , ventilation for > 48 hs (OR= 3.75, p=0.01) and emergency surgery (OR= 3.35, p=0.01) were more likely to increase the Q3 LOS.
Conclusion The rate of Q3 LOS, operative time, and AVM rupture following open resection decreased post-ARUBA, suggesting that it may have influenced the open surgical practices for unruptured AVM.
Disclosures A. Ghaith: None. M. Ghanem: None. R. Naylor: None. S. Ibrahim: None. M. Bydon: None. G. Lanzino: None.