Poster Presentation Australian and New Zealand Stroke Organisation Conference 2025

Unplanned intensive care admission after elective aneurysm repair: a potential benchmark for neurovascular procedural quality (#102)

Ronil Chandra 1 2 , Fergus Taylor 1 , Evan Urquhart 1 , Katherine Vuong 1 , Hilary Madder 3 4 , Wei-Yun Mak 5 , Lachlan Dalli 6 , Leon Lai 4 7 , Thanh Phan 6 8 , Seana Gall 9
  1. Neurointerventional Radiology , Monash Medical Centre, Monash Health , Melbourne , Victoria, Australia
  2. Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
  3. Department of Anaesthesia , Monash Health, Melbourne, Victoria, Australia
  4. Department of Surgery, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
  5. Department of Intensive Care, Monash Health, Melbourne, Victoria, Australia
  6. Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
  7. Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
  8. Department of Medicine, Monash University, Melbourne, Victoria, Australia
  9. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

 

Background/Aims:

Unplanned intensive care admission is a quality indicator reflecting procedural safety. We evaluated the incidence and factors associated with unplanned ICU admission following elective repair of unruptured intracranial aneurysms (UIAs). 

Methods:

Retrospective cohort study at a single high-volume neurovascular centre in Melbourne, Australia. Adults (≥18-years) admitted for elective repair of saccular UIAs between July 2010 and June 2024 were included. Data sources included clinical, radiological and administrative records. Outcomes were discharge destination and 30-day mortality. Multivariable logistic regression was used to identify factors associated with unplanned ICU admission, reported as adjusted odds ratios (aORs) with 95% confidence intervals(95%CIs). 

 Results:

A total of 520 patients underwent 602 elective UIA repairs (77% female, median age 57-years, IQR 50-66). Comorbidities included prior stroke (24%), ischemic heart disease (7%), cancer history (10%). Median aneurysm size was 6mm (IQR 4–8mm); 53% underwent neurosurgical clipping, 47% endovascular treatment). Unplanned ICU admission occurred after 23 (4%) procedures (median ICU stay: 2 days [IQR 1-3])​. In multivariable analysis, this was associated with intra-procedural emboli (aOR 1.55, 95%CI 1.21-1.98,p<0.001), intra-procedural rupture (aOR 1.44, 95%CI 1.25-1.66,p<0.001) and failure to extubate (aOR 1.73, 95%CI 1.50-2.00,p<0.001). These patients had lower proportions of discharge home (65% vs 96%, p<0.001) and higher 30-day mortality (9% vs 0%, p=0.001).

Conclusion:   

Unplanned ICU admission after elective UIA repair is uncommon but associated with procedural complications and poorer short-term outcomes. It may serve as a valuable patient-centred metric for benchmarking neurovascular procedural quality.