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January 2014
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The authors evaluated a national, multihospital database containing information on over 5200 patients to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. Unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care, ischemic complications, neurologic complications, and other surgical complications.
Abstract
BACKGROUND AND PURPOSE
The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate. We evaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments.
MATERIALS AND METHODS
The Premier Perspective data base was used to identify patients hospitalized between 2006–2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts.
RESULTS
A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95% CI, 0.73–1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95% CI, 1.12–1.56]; P = .0006), ischemic complications (OR = 1.51 [95% CI, 1.24–1.83]; P = .0009), neurologic complications (OR = 1.64 [95% CI, 1.18–2.27]; P = .0018), and other surgical complications (OR = 1.55 [95% CI, 1.05–2.33]; P = .0240).
CONCLUSIONS
This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.
