Race- and ethnicity-associated differences in characteristics and outcomes of treated unruptured intracranial aneurysms: an analysis of the NeuroVascular Quality Initiative–Quality Outcomes Database cerebral aneurysm registry

OBJECTIVE The objective of this study was to utilize a large, national, prospectively collected procedural registry to investigate racial and ethnic differences in aneurysm morphology, aneurysm treatment modality, and surgical outcomes among patients undergoing treatment for unruptured intracranial aneurysms (UIAs) in the US. METHODS The NeuroVascular Quality Initiative–Quality Outcomes Database was queried for patients who underwent treatment of a UIA. Comparisons of demographics, aneurysm characteristics, treatments, and outcomes were made across races and ethnicities. Due to small sample sizes in several racial and ethnic groups, non-Hispanic Whites (NHWs) were compared with all other races combined, defined as Black, Hispanic, and other non-Whites (BHONWs). Multivariate logistic regression was performed to control for known confounders. RESULTS Three thousand forty-two patients receiving treatment for UIAs were analyzed, consisting of 74.4% NHW, 12.1% Black, 7.6% Hispanic, 3.2% Asian, 1.7% American Indian, and 0.4% Pacific Islander patients. NHW patients were less frequently symptomatic (23.9% vs 33.2%, p < 0.0001), less likely to have open surgery (14.4% vs 20.4%, p < 0.0001), and more likely to have posterior circulation aneurysms treated (17.6% vs 9.2%, p < 0.0001). There was no significant difference in intraoperative complication rates (3.8% vs 4.7%, p = 0.273). NHW patients were less likely to have a postoperative complication (4.3% vs 7%, p = 0.005). Patients had similar rates of aneurysm occlusion. NHW patients were less likely to have a modified Rankin Scale (mRS) score ≥ 3 at discharge (7.8% vs 11.2%, p = 0.02), length of stay (LOS) ≥ 3 days (24.4% vs 35.5%, p < 0.0001), and be discharged to a nursing home or die (1.5% vs 2.8%, p = 0.029). After controlling for known confounders, BHONW patients had a higher rate of postoperative complications (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.07–2.43; p = 0.021), mRS score > 2 at discharge (aOR 1.72, 95% CI 1.13–2.6; p = 0.011), LOS ≥ 3 days (aOR 1.41, 95% CI 1.12–1.77; p = 0.004), and poor discharge status (aOR 2.14, 95% CI 1.10–4.09; p = 0.02). CONCLUSIONS Analysis of the largest, prospectively collected, contemporary procedural registry indicated significant racial/ethnic differences in aneurysm characteristics, treatment modalities, and outcomes in patients undergoing treatment of UIAs in the US. Further studies are needed to reveal possible solutions to mitigate these disparities.