Endovascular arterial embolization versus conservative management with nasal packing alone for severe epistaxis: a nationwide cohort study.

Background: Endovascular arterial embolization (EAE) is an effective treatment for severe epistaxis refractory to conservative management with nasal packing. However, contemporary real-world data are lacking, as are data on head-to-head comparisons of EAE versus nasal packing alone.

Methods: This was a retrospective cohort study of the Nationwide Readmissions Database (NRD) from 2016 to 2021 in the United States. Patients with severe epistaxis treated with nasal packing alone or EAE with or without nasal packing were included and followed for 180 days. Propensity score matching (PSM) for demographics, comorbidities, and hemorrhage risk factors was performed to balance patient characteristics. Primary outcome was recurrent epistaxis. Secondary outcomes include rates of non-routine hospital discharge (indicating short-term morbidity or mortality) and ischemic stroke.

Results: 25 160 patients admitted to hospital for severe epistaxis were included; 754 (3.3%) underwent EAE. After PSM, 1542 patients remained in the conservative management group, and 743 remained in the EAE group. Overall, the risk of epistaxis readmission was lower after EAE compared with conservative management (HR 0.47, 95% CI 0.26 to 0.87, P=0.016); the 180-day epistaxis readmission rate was 4.6% and 10.6%, respectively (P=0.024). EAE was significantly associated with lower rates of non-routine discharge (22.1% vs 28.9%, P=0.026), despite a higher rate of ischemic stroke (1.6% vs 0.4%, P=0.017).

Conclusions: For patients with severe epistaxis, EAE is associated with a significant reduction of epistaxis recurrence rates as well as lower rates of patient morbidity compared with nasal packing alone, despite a small but significant increase in risk of ischemic stroke.