Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jun-Jul;32(6):1065-70.
doi: 10.3174/ajnr.A2446. Epub 2011 Apr 21.

Patient outcomes are better for unruptured cerebral aneurysms treated at centers that preferentially treat with endovascular coiling: a study of the national inpatient sample 2001-2007

W Brinjikji  1 , A A Rabinstein, G Lanzino, D F Kallmes, H J Cloft
Affiliations

Patient outcomes are better for unruptured cerebral aneurysms treated at centers that preferentially treat with endovascular coiling: a study of the national inpatient sample 2001-2007

W Brinjikji et al. AJNR Am J Neuroradiol. 2011 Jun-Jul.

Abstract

Background and purpose: Practice patterns vary widely among centers with regard to the treatment of unruptured aneurysms. The purpose of the current study was to correlate outcome data with practice patterns, specifically the proportion of unruptured aneurysms treated with neurosurgical clipping versus endovascular coiling.

Materials and methods: Using the NIS, we evaluated outcomes of patients treated for unruptured aneurysms in the United States from 2001 to 2007. Hospitalizations for clipping or coiling of unruptured cerebral aneurysms were identified by cross-matching ICD codes for diagnosis of unruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms. Mortality and morbidity, measured as "discharge to long-term facility," were evaluated in relation to the fraction of cases treated with coils versus clipping as well as the annual number of unruptured aneurysms treated by individual hospitals and individual physicians.

Results: Markedly lower morbidity (P < .0001) and mortality (P = .0015) were noted in centers that coiled a higher percentage of aneurysms compared with the proportion of aneurysms clipped. Multivariate analysis showed that greater annual numbers of aneurysms treated by individual practitioners were significantly related to decreased morbidity (OR = 0.98, P < .0001), while the association between morbidity and the annual number of aneurysms treated by hospitals was not significant (OR = 1.00, P = .89).

Conclusions: Centers that treated a higher percentage of unruptured aneurysms with coiling compared with clipping achieved markedly lower rates of morbidity and mortality. Our results also confirm that treatment by high-volume practitioners is associated with decreased morbidity.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
Proportion of cases coiled and morbidity and mortality.
Fig 2.
Fig 2.
Percentage of cases treated at low-volume (≤20 cases/year) centers.
Fig 3.
Fig 3.
Distribution of clipping and coiling in relation to hospital volume at centers that practice both clipping and coiling: 1) hospitals treating ≤5 unruptured aneurysms, 2) hospitals treating 6–20 unruptured aneurysms, 3) hospitals treating 21–44 unruptured aneurysms, and 4) hospitals treating >44 unruptured aneurysms.
See this image and copyright information in PMC

Comment in

References

    1. Hoh BL, Rabinov JD, Pryor JC, et al. . In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000: effect of hospital and physician volume. AJNR Am J Neuroradiol 2003; 24: 1409– 20 - PMC - PubMed
    1. Barker FG, 2nd, Amin-Hanjani S, Butler WE, et al. . In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996–2000: the effect of hospital and surgeon volume. Neurosurgery 2003; 52: 995– 1007, discussion 1007–09 - PubMed
    1. Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J Lawrence Pool Memorial Research Symposium—controversies in the management of cerebral aneurysms. Neurosurgery 2008; 62: 183– 93, discussion 193–184 - PubMed
    1. Chyatte D, Porterfield R. Functional outcome after repair of unruptured intracranial aneurysms. J Neurosurg 2001; 94: 417– 21 - PubMed
    1. Bardach NS, Zhao S, Gress DR, et al. . Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 2002; 33: 1851– 56 - PubMed

MeSH terms