Association of travel distance and cerebral aneurysm treatment

BACKGROUND The management of cerebral aneurysms requires a significant level of expertise, and large areas of the country have limited access to such advanced neurosurgical care. The objective of this study was to examine the impact of longer travel distance on aneurysm management. METHODS Adult patients treated for cerebral aneurysms from January 1, 2013 to January 1, 2016, were retrospectively identified. Demographic data, socioeconomic data, aneurysm characteristics, and postoperative outcomes were evaluated with univariate and multivariable analysis to determine factors that influenced treatment prior to or after rupture. RESULTS Two hundred fifty aneurysms (87 ruptured) were treated during the study period. Patients treated after rupture were more likely than those treated before rupture to live in areas with lower median household income (62% vs. 45%, P = 0.009), to live further from the treatment center (68% vs. 40%, P < 0.001), and to have aneurysms in the anterior communicating artery, anterior cerebral artery, or posterior communicating artery (P < 0.001). On multivariable analysis, longer travel distance (OR 3.288, 95% CI 1.562-6.922, P = 0.002), lower income (1.899, 95% CI 1.003-3.596, P = 0.049), and aneurysm location (P = 0.035) remained significantly associated with treatment after rupture. CONCLUSIONS Patients who must travel further to receive advanced neurovascular care are more likely to receive treatment for their aneurysms only after they rupture. Further inquiry is needed to determine how to better provide neurosurgical treatment to patients living in underserved areas.