title: Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008.
abstract: OBJECTIVE
  Age might differentially affect outcomes in patients treated for unruptured cerebral aneurysms with surgical clipping versus endovascular coil therapy. We evaluated a large administrative database to determine the effect of age on outcomes in patients treated for unruptured cerebral aneurysm.
  
  
  METHODS
  Using the National Inpatient Sample, we evaluated morbidity (discharge to long-term facility) and mortality of patients undergoing clipping or coiling of unruptured cerebral aneurysms in the United States between 2001 and 2008. Outcomes were evaluated in relation to four age strata: younger than 50 years; 50 to 64 years; 65 to 79 years; and patients 80 years or older.
  
  
  RESULTS
  Patients younger than 50 years old undergoing coiling had significantly lower morbidity rates when compared to patients who underwent clipping (3.5% versus 8.1%; P<0.0001), but no difference in mortality (0.6% versus 0.6%; P=0.72). Patients between 50 and 64 years old undergoing coiling had significantly decreased morbidity (4.0% versus 13.7%; P<0.0001) and mortality (0.5% versus 1.1%; P<0.0001) when compared to patients who underwent clipping. Coiled patients 65 to 79 years old had lower morbidity (6.9% versus 26.8%; P<0.0001) and mortality (0.8% versus 2.0%; P<0.0001) compared to patients who underwent clipping. Patients aged 80 years or older undergoing coiling also had lower morbidity (9.8% versus 33.5%; P<0.0001) and mortality (2.4% versus 21.4%; P<0.0001) when compared to patients who have undergone clipping.
  
  
  CONCLUSIONS
  Patients treated with endovascular coiling have significantly less morbidity and mortality than those treated with surgical clipping, and these differences become more pronounced with age.
authors: Mayo Medical School, Mayo Clinic, Department of Neurology, 200 SW First Street, Rochester, MN 55905, USA. brinjikji.waleed@mayo.edu
authors: Waleed
authors: W
authors: Brinjikji
authors: Alejandro A
authors: AA
authors: Rabinstein
authors: Giuseppe
authors: G
authors: Lanzino
authors: David F
authors: DF
authors: Kallmes
authors: Harry J
authors: HJ
authors: Cloft
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007297:Inpatients; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D013525:Surgical Instruments; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology