title: A predictive model of outcomes during cerebral aneurysm coiling.
abstract: BACKGROUND
  Benchmarking of complications is necessary in the context of the developing path to accountable care. We attempted to create a predictive model of negative outcomes in patients undergoing cerebral aneurysm coiling (CACo).
  
  
  METHODS
  We performed a retrospective cohort study involving patients who underwent CACo from 2005 to 2009 and who were registered in the Nationwide Inpatient Sample database. A model for outcome prediction based on individual patient characteristics was developed.
  
  
  RESULTS
  Of the 10 607 patients undergoing CACo, 6056 presented with unruptured aneurysms (57.1%) and 4551 with subarachnoid hemorrhage (42.9%). The respective inpatient postoperative risks were 0.3%, 5.7%, 1.8%, 0.8%, 0.5%, 0.2%, 1.9%, and 0.1% for unruptured aneurysms, and 13.8%, 52.8%, 4.9%, 36.7%, 1%, 2.9%, 2.3%, and 0.8% for ruptured aneurysms for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, and it was found to have good discrimination.
  
  
  CONCLUSIONS
  The presented model can aid in the prediction of the incidence of postoperative complications, and can be used as an adjunct in tailoring the treatment of cerebral aneurysms.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.forename: Todd A
authors.initials: TA
authors.lastname: Mackenzie
authors.forename: Adina
authors.initials: A
authors.lastname: Fischer
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.forename: Clifford
authors.initials: C
authors.lastname: Eskey
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D019091:Critical Pathways; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000401:mortality*; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality
keywords: Aneurysm; Coil; Hemorrhage; Intervention