(A651) Unilateral versus Bilateral Temporal Artery Biopsy: A Review of the National Inpatient Sample from 2016-2021

Introduction: Giant Cell Arteritis (GCA) is often diagnosed using temporal artery biopsy (TAB). National guidelines cite only low-level evidence favoring initial unilateral TAB (uTAB) over bilateral TAB (bTAB). We report an analysis of a large-scale retrospective national database review contrasting patient outcomes and resource utilization associated with uTAB vs bTAB.

Methods: The National Inpatient Sample was interrogated to identify TAB procedures performed between 2016-2021 using relevant ICD10 codes. Patient demographics, hospital characteristics, comorbidities, and presenting complaints were collected. Outcomes included GCA diagnosis, in-hospital mortality, length of stay, complications and charge. Logistic and linear regression were performed to analyze uTAB and bTAB adjusting for patient, hospital and presenting factors while accounting for survey weights for national estimates.

Results: A weighted total of 18,310 uTAB (72%) and 7,045 bTAB (28%) patients were identified. Hispanic ethnicity and elective admissions were less likely to undergo bTAB than uTAB. Urban and private status of hospitals and headache were predictors of bTAB. GCA was diagnosed less frequently with bTAB than uTAB (OR 0.86 [0.75 - 0.98] P = 0.026). Mortality and complications were rare and did not differ between groups. There was no difference in total complication rate (OR 0.88 [0.39-1.98] P = 0.76). After adjustment, bTAB was associated with longer hospital stays (0.44 days [0.03 - 0.85] P = 0.033) and increased total charge ($7168.90 [1952.33 - 12385.46] P = 0.007).

Conclusions: Both uTAB and bTAB have comparably low rates of morbidity and mortality, while uTAB is associated with shorter hospital stay, lesser total charge, and increased diagnosis of GCA. This strengthens the AACR recommendation to favor uTAB.