title: Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms.
abstract: OBJECTIVE
  After aneurysmal subarachnoid hemorrhage (SAH), patients with clipped aneurysms have a higher incidence of neurocognitive deficits and seizures compared with patients with coiled aneurysms. It remains unknown if patients with clipped aneurysms also have a higher incidence of other in-hospital complications.
  
  
  METHODS
  We used data from the Registry of the Canadian Stroke Network on consecutive patients admitted to hospital with aneurysmal SAH. Patients who died within 2 days after admission were excluded. Baseline characteristics, incidence of various in-hospital complications within 30 days after admission, length of stay, poor functional outcome (modified Rankin Scale score at discharge of ≥3), and mortality were compared between patients with clipped versus coiled aneurysms.
  
  
  RESULTS
  Of the 931 patients, 548 (59%) were clipped and 383 (41%) coiled. Baseline characteristics were similar. Compared with patients with coiled aneurysms, patients with clipped aneurysms had a higher incidence of in-hospital complications (37.2% versus 24.5% of patients; P<0.0001), poor functional outcome at discharge (69.4% versus 51.4%; P<0.0001), mortality (at discharge: 14.6% versus 9.1%; P=0.01), and a longer length of stay (17 [interquartile range, 11 to 29] versus 13 [interquartile range, 7 to 22] days; P<0.0001). Higher incidences were observed for urinary tract infection (P=0.02), pneumonia (P=0.01), cardiac/respiratory arrest (P=0.007), seizure (P=0.01), and decubitus ulcer (P=0.02). Urinary tract infection, pneumonia, cardiac/respiratory arrest, and seizure were independent predictors of poor functional outcome.
  
  
  CONCLUSIONS
  Patients with clipped aneurysms have a higher incidence of in-hospital complications than patients with coiled aneurysms, which attributes to a higher risk of poor functional outcome and death and an increased length of stay.
authors.affiliation: Department of Medicine, Division of Neurology, University Health Network, University of Toronto, Toronto, Canada. m.d.i.vergouwen@umcutrecht.nl
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Casaubon
authors.forename: Melissa
authors.initials: M
authors.lastname: Stamplecoski
authors.forename: Annette
authors.initials: A
authors.lastname: Robertson
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012042:Registries; D013525:Surgical Instruments / Q000009:adverse effects*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology