Impact of Psychiatric Comorbidities on Healthcare Resource Utilization in Patients Undergoing Venous Sinus Stenting for Idiopathic Intracranial Hypertension.

Abstract

Venous sinus stenting (VSS) is used to treat medically refractory idiopathic intracranial hypertension (IIH). Psychiatric comorbidities, including anxiety, depression, and personality disorders, are commonly seen in patients with IIH due to the chronic nature of their symptoms. Our study analyzes the impact of psychiatric comorbidities on healthcare resource utilization after VSS for IIH. This was a retrospective study using the TriNetX database to identify patients who underwent VSS for IIH. Patients were stratified based on the presence or absence of psychiatric comorbidities such as schizophrenia, affective disorders, anxiety, and behavioral syndromes associated with psychological disturbances and personality disorders. Propensity score matching was used to adjust for baseline differences between the two cohorts. Outcomes of interest were repeat surgical intervention, emergency department (ED) visits, and symptoms such as papilledema, headache, vision changes, or pulsatile tinnitus. Propensity score matching was used to adjust for baseline differences between the 2 cohorts. Of 1468 patients who underwent VSS, 840 patients (57.2%) had psychiatric comorbidities and 628 patients (42.8%) did not have any psychiatric comorbidities. After propensity score matching for baseline demographics and preoperative symptoms of IIH, patients with psychiatric comorbidities had higher odds of repeat surgical interventions (odds ratio [OR] = 1.681, 95% CI 1.090-2.589, P = .017), ED visits (OR = 1.727, 95% CI: 1.250-2.386, P < .001), and headaches (OR = 1.834, 95% CI: 1.235-2.722, P = .002) after VSS compared with those without psychiatric comorbidities. There were no significant differences in odds of papilledema (OR = 0.987, 95% CI: 0.719-1.355, P = .935), visual changes (OR = 1.186, 95% CI: 0.873-1.611, P = .274), or pulsatile tinnitus (OR = 1.314, 95% CI: 0.829-2.081, P = .243). IIH patients with psychiatric comorbidities experience higher rates of ED visits, repeat surgical intervention, and headaches after VSS. These findings highlight the importance of considering psychiatric comorbidities during preoperative counselling and in planning postoperative care for this population.