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.