Document Detail


Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database.
MedLine Citation:
PMID:  18518722     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The most appropriate treatment for cerebral aneurysms, both ruptured and unruptured, is currently under debate, and updated guidelines have yet to be defined. The authors attempted to identify trends in therapy for cerebral aneurysms in the US as well as outcomes. METHODS: The authors retrospectively reviewed data from the Nationwide Inpatient Sample hospital discharge database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) for the period 1993-2003. Multiple variables were categorized and subjected to statistical analysis for International Classification of Diseases, 9th Revision, Clinical Modification codes related to subarachnoid hemorrhage (SAH), unruptured aneurysm, and clipping and endovascular treatment of cerebral aneurysm. RESULTS: During the study period, the numbers of discharges remained stable for SAH but doubled for unruptured aneurysms. Concomitantly, the number of aneurysms treated with clip placement remained stable, and the number treated by means of endovascular procedures doubled. By the study's end, the mortality rates had decreased 20% for SAH and 50% for unruptured aneurysms. Increasing age was associated with increased mortality rates, mean length of hospital stay (LOS), and mean charges (p < 0.01). Endovascular treatment was used more often in older patients (p < 0.01). Teaching status and larger hospital size were associated with higher charges and longer hospital stays (although the association was not statistically significant) and with better outcomes (p < 0.05) and lower mortality rates (p < 0.05), especially in patients who underwent aneurysm clipping (p < 0.01). Endovascular treatment was associated with significantly higher mortality rates in small hospitals (p < 0.001) and steadily increasing morbidity rates (45%). Morbidity rates, mean LOS, and mean charges were higher for aneurysm clipping (p < 0.01). CONCLUSIONS: From 1993 to 2003, endovascular techniques for aneurysm occlusion have been increasingly used, while the use of surgical clipping procedures has remained stable. Toward the end of the study period, better overall outcomes were observed in the treatment of cerebral aneurysms, both ruptured and unruptured. Large academic centers were associated with better results, particularly for surgical clip placement.
Authors:
Norberto Andaluz; Mario Zuccarello
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  108     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-07-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1163-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, University of South Florida, Tampa, FL, USA. nandaluz@hsc.usf.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Angioplasty / trends*,  utilization
Child
Databases, Factual
Embolization, Therapeutic / trends*,  utilization
Hospital Mortality
Hospitalization / statistics & numerical data
Humans
Intracranial Aneurysm / diagnosis,  mortality,  therapy*
Middle Aged
Retrospective Studies
Treatment Outcome
United States / epidemiology
Comments/Corrections
Comment In:
J Neurosurg. 2008 Jun;108(6):1162   [PMID:  18518721 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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