title: Comparative effectiveness of ruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling.
abstract: OBJECTIVE
  The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate. We evaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments.
  
  
  METHODS
  The Premier Perspective data base was used to identify patients hospitalized between 2006-2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts.
  
  
  RESULTS
  A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95% CI, 0.73-1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95% CI, 1.12-1.56]; P = .0006), ischemic complications (OR = 1.51 [95% CI, 1.24-1.83]; P = .0009), neurologic complications (OR = 1.64 [95% CI, 1.18-2.27]; P = .0018), and other surgical complications (OR = 1.55 [95% CI, 1.05-2.33]; P = .0240).
  
  
  CONCLUSIONS
  This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.
authors.affiliation: Departments of Radiology.
authors.forename: J S
authors.initials: JS
authors.lastname: McDonald
authors.forename: R J
authors.initials: RJ
authors.lastname: McDonald
authors.forename: J
authors.initials: J
authors.lastname: Fan
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
authors.forename: H J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000628:therapy*; D002548:Cerebral Revascularization / Q000401:mortality* / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology