title: Increased risk for complications following diagnostic cerebral angiography in older patients: Trends from the Nationwide Inpatient Sample (1999-2009).
abstract: The full utility of diagnostic cerebral angiography, an invasive cerebrovascular imaging technique, is currently debated. Our goal was to determine trends in diagnostic cerebral angiography utilization and associated complications from 1999 through 2009. The National Inpatient Sample (NIS) was used to identify patients who received primary cerebral angiography from 1999-2009 in the United States. We observed trends in discharge volume, total mean charge, and post-procedural complications for this population. Data was based on sample projections and analyzed using univariate and multivariate regression. There were a total of 424,105 discharges indicating primary cerebral angiography nationwide from 1999-2009. The majority of these cases (65%) were in patients older than 55years. Embolic stroke was the most frequent complication, particularly in the oldest age bracket, occurring in 16,304 patients. The risk for complications increased with age (p<0.0001) and with other underlying health conditions. Pulmonary, deep vein thrombosis, and renal associated comorbidities resulted in the greatest risk for developing post-procedural complications. Throughout the study period case volume for cerebral angiography remained constant while total charge per patient increased from $17,365 in 1999 to $45,339 in 2009 (p<0.001). While the overall complication rate for this invasive procedure is relatively low, the potential risk for embolic stroke in older patients is significant. It is worth considering less invasive diagnostic techniques for an older and at risk patient population.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave. Rm. M779, San Francisco, CA 94143-0112, USA. Electronic address: Omar.Choudhri@ucsf.edu.
authors.forename: Omar
authors.initials: O
authors.lastname: Choudhri
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, CA 94305, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schoen
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, CA 94305, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Mantha
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, CA 94305, USA.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Feroze
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, CA 94305, USA.
authors.forename: Rohaid
authors.initials: R
authors.lastname: Ali
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave. Rm. M779, San Francisco, CA 94143-0112, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, CA 94305, USA; Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Huy M
authors.initials: HM
authors.lastname: Do
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002533:Cerebral Angiography / Q000009:adverse effects* / Q000191:economics / Q000639:trends*; D015897:Comorbidity; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: CT angiography; Cerebral angiography; Cerebrovascular imaging; Complications; National Inpatient Sample; Population outcomes