title: Evaluation of time to aneurysm treatment following subarachnoid hemorrhage: comparison of patients treated with clipping versus coiling.
abstract: BACKGROUND
  Prior studies of aneurysmal subarachnoid hemorrhage (SAH) have shown that treatment at teaching institutions and decreased time to surgery are factors that correlate with improved patient outcome. We aimed to individually evaluate the effect of teaching institution treatment on rates of surgical clipping or endovascular coiling.
  
  
  METHODS
  Patients with SAH treated by either aneurysm clipping or coiling between 2002 and 2010 in the Nationwide Inpatient Sample were analyzed. Time to aneurysm treatment was dichotomized to >3 days or ≤3 days and evaluated by multivariable logistic regression modeling, controlling for patient and hospital covariates. Identified predictors for prolonged time to procedure were compared between the clipping and coiling populations.
  
  
  RESULTS
  Between 2002 and 2010 there were 90 684 SAH admissions with subsequent clipping and coiling procedures. Treatment at teaching hospitals was associated with faster time to clipping (OR 0.60, 95% CI 0.44 to 0.80, p=0.001) but not coiling procedures (p=0.66). Likewise, older age (≥80 years) was associated with delays to clipping (p<0.05) but not coiling procedures (p>0.05). Patients with delayed time to treatment were associated with increased rates of moderate to severe neurological disability.
  
  
  CONCLUSIONS
  Older patients with SAH and those treated at non-teaching hospitals were more likely to have delays to aneurysm clipping procedures. These associations were unique to open surgery as age and hospital teaching status did not affect time to coiling procedures.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Attenello
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Reid
authors.affiliation: Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wen
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Cen
authors.affiliation: Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: May
authors.initials: M
authors.lastname: Kim-Tenser
authors.affiliation: Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Russin
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Amar
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Giannotta
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tenser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D061665:Time-to-Treatment / Q000639:trends; D016896:Treatment Outcome
keywords: Aneurysm; Hemorrhage; Statistics; Subarachnoid