title: Paradoxical trends in the management of unruptured cerebral aneurysms in the United States: analysis of nationwide database over a 10-year period.
abstract: OBJECTIVE
  The objective of this study was to characterize demographics, treatments, and outcomes in the management of unruptured cerebral aneurysms in the United States using a national healthcare database.
  
  
  METHODS
  Clinical data were derived from the Nationwide Inpatient Sample for the years 1997 through 2006. Patients with unruptured cerebral aneurysms were identified using the appropriate International Classification of Diseases, 9th Revision code (437.3). Hospitalizations, length of stay, hospital charges, discharge pattern, age and gender distribution, and nature of intervention were analyzed. A Bureau of Labor statistics tool was used to adjust hospital and national charges for inflation. Population-adjusted rates were calculated using population estimates generated by the U.S. Census Bureau.
  
  
  RESULTS
  Over 100 000 records were retrieved for analysis. During the time period studied, there was a 75% increase in the number of hospitalizations associated with unruptured cerebral aneurysms. Inflation adjusted hospital charges increased by 60%, whereas the total national bill increased by 200%. Overall, length of stay decreased by 37% and in-hospital mortality rates decreased by 54%. The increasing number of hospitalizations and total national charges related to inpatient treatment of unruptured aneurysms were significantly associated with endovascular treatment rather than surgical clipping.
  
  
  CONCLUSIONS
  Despite recent studies suggesting a low risk of rupture of incidentally diagnosed cerebral aneurysms, data from this study suggest an increasing trend of treatment for this entity in the United States. Furthermore, endovascular intervention is now the major driving force behind the increasing overall national charges. Given the current healthcare climate, the impact of these trends warrants discussion and debate.
authors.affiliation: Department of Neurological Surgery & Brain Repair, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Huang
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.forename: Katheryne
authors.initials: K
authors.lastname: Downes
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.forename: Harry R
authors.initials: HR
authors.lastname: van Loveren
authors.forename: Siviero
authors.initials: S
authors.lastname: Agazzi
mesh_terms: D017542:Aneurysm, Ruptured; D017281:Cost of Illness; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017722:Hospital Charges / Q000639:trends; D017052:Hospital Mortality; D006760:Hospitalization / Q000639:trends; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology