Trends in Epistaxis Embolization in the United States

A Study of the Nationwide Inpatient Sample 2003-2010

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: Endovascular embolization has emerged as a viable adjunct and alternative to surgical ligation in selected cases of epistaxis refractory to nasal packing. A large administrative database was used to study outcomes, complications, and trends in utilization of surgical and endovascular treatments for epistaxis. Materials and Methods: With the Nationwide Inpatient Sample from 2003 to 2010, patients with a primary diagnosis of epistaxis undergoing surgical ligation and/or endovascular embolization were identified. Trends in the use of these procedures from 2003 to 2010 were examined. Three groups of patients were defined: those who underwent (i) surgical ligation, (ii) endovascular embolization, or (iii) both. Demographic variables, comorbidities, and outcomes were compared across groups. Results: Among a total of 69,410 patients identified, 64,289 (92.6%) underwent surgical ligation alone for epistaxis, 4,440 (6.4%) underwent endovascular embolization alone, and 681 (1.0%) underwent both treatments. Use of endovascular embolization for epistaxis increased from 2.8% of cases in 2003 to 10.7% of cases in 2010 (P<.0001). Patients who underwent endovascular embolization had similar mortality rates as those who underwent surgical ligation (2.1% [93 of 4,440] vs 2.1% [1,328 of 64,289]; P =.89). Endovascular embolization was associated with significantly higher rates of stroke (0.9% [41 of 4,440] vs 0.1% [34/64,289]; P<.0001) and hematoma (1.9% [83 of 4,440] vs 0.4% [239 of 64,289]; P<.0001). Conclusions: Use of endovascular embolization for treatment of epistaxis increased significantly between 2003 and 2010. Patients who underwent endovascular embolization had similar mortality rates but higher stroke rates compared with those who underwent surgical ligation.

Original languageEnglish (US)
Pages (from-to)969-973
Number of pages5
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Epistaxis
Ligation
Inpatients
Stroke
Mortality
Nose
Hematoma
Comorbidity
Therapeutics
Demography
Outcome Assessment (Health Care)
Databases

Keywords

  • CCI
  • CCS
  • Charlson comorbidity index
  • Clinical Classification Software
  • ICD-9
  • International Classification of Diseases, Ninth Revision
  • Nationwide Inpatient Sample
  • NIS
  • TIA
  • transient ischemic attack

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{5e1c69cdaf494979b25d1ef44025e6fa,
title = "Trends in Epistaxis Embolization in the United States: A Study of the Nationwide Inpatient Sample 2003-2010",
abstract = "Purpose: Endovascular embolization has emerged as a viable adjunct and alternative to surgical ligation in selected cases of epistaxis refractory to nasal packing. A large administrative database was used to study outcomes, complications, and trends in utilization of surgical and endovascular treatments for epistaxis. Materials and Methods: With the Nationwide Inpatient Sample from 2003 to 2010, patients with a primary diagnosis of epistaxis undergoing surgical ligation and/or endovascular embolization were identified. Trends in the use of these procedures from 2003 to 2010 were examined. Three groups of patients were defined: those who underwent (i) surgical ligation, (ii) endovascular embolization, or (iii) both. Demographic variables, comorbidities, and outcomes were compared across groups. Results: Among a total of 69,410 patients identified, 64,289 (92.6{\%}) underwent surgical ligation alone for epistaxis, 4,440 (6.4{\%}) underwent endovascular embolization alone, and 681 (1.0{\%}) underwent both treatments. Use of endovascular embolization for epistaxis increased from 2.8{\%} of cases in 2003 to 10.7{\%} of cases in 2010 (P<.0001). Patients who underwent endovascular embolization had similar mortality rates as those who underwent surgical ligation (2.1{\%} [93 of 4,440] vs 2.1{\%} [1,328 of 64,289]; P =.89). Endovascular embolization was associated with significantly higher rates of stroke (0.9{\%} [41 of 4,440] vs 0.1{\%} [34/64,289]; P<.0001) and hematoma (1.9{\%} [83 of 4,440] vs 0.4{\%} [239 of 64,289]; P<.0001). Conclusions: Use of endovascular embolization for treatment of epistaxis increased significantly between 2003 and 2010. Patients who underwent endovascular embolization had similar mortality rates but higher stroke rates compared with those who underwent surgical ligation.",
keywords = "CCI, CCS, Charlson comorbidity index, Clinical Classification Software, ICD-9, International Classification of Diseases, Ninth Revision, Nationwide Inpatient Sample, NIS, TIA, transient ischemic attack",
author = "Waleed Brinjikji and Kallmes, {David F} and Cloft, {Harry J.}",
year = "2013",
month = "7",
doi = "10.1016/j.jvir.2013.02.035",
language = "English (US)",
volume = "24",
pages = "969--973",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "7",

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T1 - Trends in Epistaxis Embolization in the United States

T2 - A Study of the Nationwide Inpatient Sample 2003-2010

AU - Brinjikji, Waleed

AU - Kallmes, David F

AU - Cloft, Harry J.

PY - 2013/7

Y1 - 2013/7

N2 - Purpose: Endovascular embolization has emerged as a viable adjunct and alternative to surgical ligation in selected cases of epistaxis refractory to nasal packing. A large administrative database was used to study outcomes, complications, and trends in utilization of surgical and endovascular treatments for epistaxis. Materials and Methods: With the Nationwide Inpatient Sample from 2003 to 2010, patients with a primary diagnosis of epistaxis undergoing surgical ligation and/or endovascular embolization were identified. Trends in the use of these procedures from 2003 to 2010 were examined. Three groups of patients were defined: those who underwent (i) surgical ligation, (ii) endovascular embolization, or (iii) both. Demographic variables, comorbidities, and outcomes were compared across groups. Results: Among a total of 69,410 patients identified, 64,289 (92.6%) underwent surgical ligation alone for epistaxis, 4,440 (6.4%) underwent endovascular embolization alone, and 681 (1.0%) underwent both treatments. Use of endovascular embolization for epistaxis increased from 2.8% of cases in 2003 to 10.7% of cases in 2010 (P<.0001). Patients who underwent endovascular embolization had similar mortality rates as those who underwent surgical ligation (2.1% [93 of 4,440] vs 2.1% [1,328 of 64,289]; P =.89). Endovascular embolization was associated with significantly higher rates of stroke (0.9% [41 of 4,440] vs 0.1% [34/64,289]; P<.0001) and hematoma (1.9% [83 of 4,440] vs 0.4% [239 of 64,289]; P<.0001). Conclusions: Use of endovascular embolization for treatment of epistaxis increased significantly between 2003 and 2010. Patients who underwent endovascular embolization had similar mortality rates but higher stroke rates compared with those who underwent surgical ligation.

AB - Purpose: Endovascular embolization has emerged as a viable adjunct and alternative to surgical ligation in selected cases of epistaxis refractory to nasal packing. A large administrative database was used to study outcomes, complications, and trends in utilization of surgical and endovascular treatments for epistaxis. Materials and Methods: With the Nationwide Inpatient Sample from 2003 to 2010, patients with a primary diagnosis of epistaxis undergoing surgical ligation and/or endovascular embolization were identified. Trends in the use of these procedures from 2003 to 2010 were examined. Three groups of patients were defined: those who underwent (i) surgical ligation, (ii) endovascular embolization, or (iii) both. Demographic variables, comorbidities, and outcomes were compared across groups. Results: Among a total of 69,410 patients identified, 64,289 (92.6%) underwent surgical ligation alone for epistaxis, 4,440 (6.4%) underwent endovascular embolization alone, and 681 (1.0%) underwent both treatments. Use of endovascular embolization for epistaxis increased from 2.8% of cases in 2003 to 10.7% of cases in 2010 (P<.0001). Patients who underwent endovascular embolization had similar mortality rates as those who underwent surgical ligation (2.1% [93 of 4,440] vs 2.1% [1,328 of 64,289]; P =.89). Endovascular embolization was associated with significantly higher rates of stroke (0.9% [41 of 4,440] vs 0.1% [34/64,289]; P<.0001) and hematoma (1.9% [83 of 4,440] vs 0.4% [239 of 64,289]; P<.0001). Conclusions: Use of endovascular embolization for treatment of epistaxis increased significantly between 2003 and 2010. Patients who underwent endovascular embolization had similar mortality rates but higher stroke rates compared with those who underwent surgical ligation.

KW - CCI

KW - CCS

KW - Charlson comorbidity index

KW - Clinical Classification Software

KW - ICD-9

KW - International Classification of Diseases, Ninth Revision

KW - Nationwide Inpatient Sample

KW - NIS

KW - TIA

KW - transient ischemic attack

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