A27 Timing of complications after elective aneurysm repair: insights to guide postinterventional observation

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Background/Introduction Trends toward shorter length of stay question the optimal duration of observation after unruptured intracranial aneurysm (UIA) repair. Evidence on the timing of complications remains limited. Objective/Purpose To evaluate the timing, severity, and predictors of management-affecting complications following UIA repair. Methods/Case Description In this multi-center observational study, adult patients who underwent endovascular or open surgical UIA repair (January 2015 - September 2024) were included if they experienced at least one management-affecting complication (Cardiovascular and Interventional Radiological Society of Europe grade ≥2) during initial hospitalization or were readmitted within 30 days.Timing of the first management-affecting complication was the primary outcome. Kaplan–Meier analyses were used to assess complication timing, and regression analyses evaluated associations with delayed complication onset. Results/Findings Among 8095 treated patients (7137 endovascular, 958 surgical), 501 patients (mean age, 61 years ± 8; 72.1% female) experienced management-affecting complications or were readmitted within 30 days. Intraprocedural complications occurred in 172 patients (34.3%), and 305 patients experienced postprocedural complications during initial hospitalization without previous intraprocedural complications (60.9%). Complication severity as per Cardiovascular and Interventional Radiological Society of Europe grading did not decrease during the postprocedural period. Among patients without intraprocedural complications during endovascular treatment, 29.0% of postprocedural complications occurred on the day of treatment and 91.2% up to day 2 (following surgery: 23.9% and 94.0% up to day 5). No strong or consistent predictors of delayed complication onset were identified for either treatment modality. Discussion/Conclusions/Learning Points Capturing more than 90% of postprocedural complications would have required a minimum of two days of observation following endovascular treatment and five days after open surgical intervention. Same-day discharge would have resulted in failure to detect 71% of complications after endovascular procedures and 76% after open surgery. The absence of robust predictors of delayed complications limits the ability to safely individualize shortened observation strategies.

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