Effects of Preoperative Vascular Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids’ Inpatient Database

Objectives: The aim is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.

Methods: The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database was queried for all cases of JNA operative management between the years of 1997 and 2016. Cases were stratified based on whether the patient received preoperative vascular embolization. A multiple linear regression (MLR) was used to predict the effect of embolization on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression (BLR) for PVE patients.

Results: A total of 473 patients were identified who underwent JNA surgical resection in this time period. The use of PVE has increased from 0% in 1997 and 2000 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving vascular embolization were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.

Conclusion: PVE is becoming increasingly prevalent in JNA surgical management. Embolization results in decreased hospital LOS and a lower odds of needing blood transfusions. While embolization increases the cost of admission, this trend should be re-evaluated as this procedure become more widespread.