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Introduction Intracranial mycotic aneurysms are associated with high mortality. This is the first population-based study to examine treatment-based patient outcomes during hospitalization for intracranial mycotic aneurysms.Methods We utilized ICD-10 codes to identify patients hospitalized with mycotic aneurysms in the 2017-2022 National Inpatient Sample (NIS) database. Cohorts were based on conservative management, craniotomy for aneurysm clipping, or endovascular treatment with embolization. Primary outcomes were in-hospital mortality, favorable discharge to home or short-term hospital, and length of stay (LOS). Cerebral vasospasm was a secondary outcome. Multivariable regression analysis was performed adjusting for age, sex, comorbidity burden (elixhauser comorbidity index), aneurysm location, multiplicity, and symptom severity (National Inpatient Sample-Subarachnoid Severity Score/NIS-SSS).Results Of 515 patients with mycotic aneurysms, 67.0% underwent conservative management, 7.0% underwent craniotomy, and 26.0% of patients underwent endovascular therapy. Patients managed conservatively were older, had lower symptom severity, and had higher rates of multiple aneurysms. These factors were similar between craniotomy and endovascular groups. Anterior circulation aneurysms were most often treated with craniotomy. Endovascular therapy (E) was associated with lower rates of in-hospital mortality (E: 14.9% vs. Cr: 30.6%, p=0.049 vs. Co: 27.2%, p=0.004) and increased LOS (E: 24 vs. Cr: 16.5 days, p=0.046 vs. Co: 17 days, p<0.001) than craniotomy (Cr) and conservative (Co) management. Rates of favorable discharge were comparable between groups. Lower vasospasm rates were observed in conservatively managed patients (Co: 1.7% vs. Cr: 22.2%, p<0.001 vs. E:15.7%, p<0.001). Multivariate analysis showed endovascular therapy was associated with lower odds of in-hospital mortality (AOR=0.44, CI=[0.22-0.86], p=0.02) and increased LOS (β=7.77, CI=[2.13-13.41] compared to conservative management.Conclusion In this nationally representative sample, endovascular therapy was also associated with lower in-hospital mortality rates and increased LOS compared to craniotomy and conservative management. While this study presents endovascular therapy as beneficial, findings should be interpreted in the context of symptom severity, aneurysm location, sex, and age. Current literature on mycotic aneurysms is sparse and more granular data evaluating the impact of mycotic aneurysm characteristics, including size, re-rupture, and multiplicity, is needed.Disclosures P. Reddi: None. M. Rashad: None. K. John: None. S. Koduri: None. Z. Wilseck: None. A. Nguyen: None. G. Thompson: None.Abstract O-071 Table 1Demographics, baseline characteristics, in-hospital diagnoses, and proceduresVariableTotal CohortConservative [1]Craniotomy [2]Endovascular [3]p [1 vs 2]p [1 vs 3]p [2 vs 3]51534536134Age (median [IQR])53.0 [37.0-66.5]57.0 [43.0-69.0]47.0 [34.5-59.8]42.5 [32.2-60.5]0.008<0.0010.410Female (N, %)188 (36.5%)139 (40.3%)5 (13.9%)44 (32.8%)0.0040.1290.037NIS-SSS (median [IQR])1.0 [0.0-4.0]1.0 [0.0-3.0]4.0 [3.0-7.0]3.0 [1.0-4.0]<0.001<0.0010.068Elixhauser Comorbidity Index (median [IQR])17.0 [10.0-25.0]18.0 [11.0-26.0]14.0 [12.0-22.0]14.0 [8.0-22.0]0.1600.0020.539Ruptured (N, %)442 (85.8%)292 (84.6%)34 (94.4%)116 (86.6%)0.1400.6680.239Multiple Aneurysms (N, %)15 (2.9%)3 (0.9%)3 (8.3%)9 (6.7%)0.013<0.0010.716Race (N, %)White336 (65.2%)218 (63.2%)25 (69.4%)93 (69.4%)0.4550.2780.850Black81 (15.7%)58 (16.8%)6 (16.7%)17 (12.7%)1.0000.2700.584Hispanic53 (10.3%)37 (10.7%)3 (8.3%)13 (9.7%)1.0000.8631.000Asian16 (3.1%)12 (3.5%)0 (0.0%)4 (3.0%)0.6411.0000.582Native3 (0.6%)2 (0.6%)0 (0.0%)1 (0.7%)1.0001.0001.000Other9 (1.7%)6 (1.7%)0 (0.0%)3 (2.2%)1.0000.7251.000Median Household Income (N, %)0-25th Percentile157 (30.5%)103 (29.9%)14 (38.9%)40 (29.9%)0.3511.0000.40926-50th Percentile130 (25.2%)91 (26.4%)8 (22.2%)31 (23.1%)0.6960.4861.00051-75th Percentile108 (21.0%)75 (21.7%)8 (22.2%)25 (18.7%)1.0000.4560.64476-100th Percentile109 (21.2%)67 (19.4%)6 (16.7%)36 (26.9%)0.8270.1110.286Aneurysm Location (N, %)Anterior Circulation115 (22.3%)18 (5.2%)30 (83.3%)67 (50.0%)<0.001<0.001<0.001Posterior Circulation31 (6.0%)8 (2.3%)1 (2.8%)22 (16.4%)0.618<0.0010.059Hypertension268 (52.0%)190 (55.1%)16 (44.4%)62 (46.3%)0.2840.1081.000Prothrombotic Disorder74 (14.4%)51 (14.8%)6 (16.7%)17 (12.7%)0.8060.6600.595Meningitis9 (1.7%)4 (1.2%)1 (2.8%)4 (3.0%)0.3950.2541.000Smoker115 (22.3%)76 (22.0%)5 (13.9%)34 (25.4%)0.2890.4660.183Coma53 (10.3%)29 (8.4%)10 (27.8%)14 (10.4%)0.0020.4940.020Intraparenchymal Hemorrhage3 (0.6%)0 (0.0%)0 (0.0%)3 (2.2%)1.0000.0271.000Seizure63 (12.2%)42 (12.2%)5 (13.9%)16 (11.9%)0.7901.0000.798Hydrocephalus79 (15.3%)27 (7.8%)10 (27.8%)42 (31.3%)<0.001<0.0010.847Deep Vein Thrombosis9 (1.7%)5 (1.4%)0 (0.0%)4 (3.0%)1.0000.2700.598Atrial Fibrillation125 (24.3%)93 (27.0%)6 (16.7%)26 (19.4%)0.2490.0960.818Ventilator14 (2.7%)11 (3.2%)1 (2.8%)2 (1.5%)1.0000.5290.512External Ventricular Drain68 (13.2%)18 (5.2%)14 (38.9%)36 (26.9%)<0.001<0.0010.207Tracheostomy63 (12.2%)39 (11.3%)5 (13.9%)19 (14.2%)0.6180.4231.000PEG/G-tube104 (20.2%)73 (21.2%)9 (25.0%)22 (16.4%)0.6680.2610.251Ventricular Shunt7 (1.4%)1 (0.3%)1 (2.8%)5 (3.7%)0.1920.0071.000Abstract O-071 Table 2In-hospital outcomesVariableTotal CohortConservativeCraniotomyEndovascularp [1 vs 2]p [1 vs 3]p [2 vs 3]In-hospital Mortality (N, %)125 (24.3%)94 (27.2%)11 (30.6%)20 (14.9%)0.7000.0040.049Length of Stay (median [IQR])19.0 [10.0-34.0]17.0 [8.0-32.0]16.5 [12.0-29.2]24.0 [15.0-39.8]0.778<0.0010.046Discharge Home or Short-term Hospital (N, %)45 (8.7%)27 (7.8%)2 (5.6%)16 (11.9%)1.0000.1500.368Cerebral Vasospasm (N, %)35 (6.8%)6 (1.7%)8 (22.2%)21 (15.7%)<0.001<0.0010.467Abstract O-071 Table 3Mutivariate analyses of in-hospital outcomesOutcomeAOR or ß coefficient[95% Conf. Int.]p-valueCraniotomy vs. ConservativeIn-hospital Mortality0.931[0.294-2.887]0.90Discharge Home or Short-Term Hospital2.414[0.278-16.054]0.37Length of Stay4.363[-6.092-14.818]0.41Endovascular vs. ConservativeIn-hospital Mortality0.442[0.217-0.864]0.02Discharge Home or Short-Term Hospital1.343[0.581-2.990]0.48Length of Stay7.767[2.125-13.409]0.01Craniotomy vs. EndovascularIn-hospital Mortality1.864[0.714-4.760]0.19Discharge Home or Short-Term Hospital0.606[0.086-2.697]0.55Length of Stay-8.678[-17.852-0.497]0.06