[Coiling vs. clipping: hospital stay and procedure time in intracranial aneurysm treatment].
OBJECTIVE
Evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center.


METHODS
Retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio.


RESULTS
Clinical admission grade (rupt. A: Hunt and Hess grade 1 - 3: clip: 73 % coil: 72 %) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1/13.8 % coil: 45.5 / 10.3 % non-rupt. A: 88.2/0 % coil: 88.5/1.3 %) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p < 0.01; non-rupt. A: coil: 164 min, clip: 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6 d, p < 0.01; non-rupt. A: coil: 1.5 d; clip: 2 d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4 d; clip: 26.8 d, p < 0.01; non-rupt. A: coil: 9.2 d; clip: 17.5 d; p = 0.01).The discharge to home ratio did not differ (rupt. A: clip: 31.6 % coil: 29.7 % non-rupt. A: clip: 74.5 % coil: 80.5 %).


CONCLUSIONS
In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.
Brunken
M
M
Abteilung für Neurochirurgie, Asklepios-Klinik Altona, Hamburg. m.brunken@asklepios.com
Kehler
U
U
Fiehler
J
J
Leppien
A
A
Eckert
B
B
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D023261:Glasgow Outcome Scale; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D009460:Neurologic Examination; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed