Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm.
OBJECTIVE
To determine the hospital mortality rates associated with elective surgical clipping and endovascular coiling of unruptured intracranial aneurysms.


METHODS
We identified a cohort of patients electively admitted to US hospitals with the diagnosis of unruptured intracranial aneurysm from the National Inpatient Sample database for the years 2000 through 2006. Patient demographics, hospital-associated complications, and in-hospital mortality were compared among the treatment groups. A multivariate logistic regression analysis was used to identify independent variables associated with hospital mortality. Cochrane-Armitage test was used to assess the trend of hospital use of these procedures.


RESULTS
After data cleansing, 3738 (34.3%) patients had aneurysm clipping and 3498 (32.1%) had endovascular coiling. The basic demographics including age, race, and comorbidity indices were similar between the groups. The length of hospital stay was longer in the clipped population (median 4 versus 1 day; P<0.0001), incurring a higher hospital charge in the coiled population (median $42 070 versus $38 166; P<0.0001). Hospital mortality was higher in the clipped population: 60 (1.6%) versus 20 (0.57%; adjusted odds ratio 3.63; 95% CI, 1.57, 8.42). Perioperative intracerebral hemorrhage and acute ischemic stroke were higher in the clipped population. The rate of hospital use of the endovascular coiling has increased over the years included in this study (<0.0001).


CONCLUSIONS
Elective coiling of unruptured intracranial aneurysms is associated with fewer deaths and perioperative complications compared with elective clipping. The trend of hospital use of the coiling procedures has increased during recent years.
Department of Neurology, St. Louis University, St. Louis, MO 63104, USA. aalshekh@slu.edu
Amer
A
Alshekhlee
Sonal
S
Mehta
Randall C
RC
Edgell
Nirav
N
Vora
Eli
E
Feen
Afshin
A
Mohammadi
Sushant P
SP
Kale
Salvador
S
Cruz-Flores
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D013525:Surgical Instruments / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*