title: Clipping and Coiling of Unruptured Intracranial Aneurysms Among Medicare Beneficiaries, 2000 to 2010.
abstract: OBJECTIVE
  Endovascular coiling therapy is increasingly popular for obliteration of unruptured intracranial aneurysms, but older patients face higher procedural risks and shorter periods during which an untreated aneurysm may rupture causing subarachnoid hemorrhage (SAH). We assessed trends in clipping and coiling of unruptured intracranial aneurysms, outcomes after clipping and coiling of unruptured intracranial aneurysms, and in SAH among Medicare beneficiaries.
  
  
  METHODS
  Using 2000 to 2010 Medicare Provider Analysis and Review data, we identified 2 cohorts of patients admitted electively for clipping or coiling of an unruptured aneurysm: (1) utilization cohort (2000-2010): patients ≥65 years enrolled ≥1 month in a given year and (2) outcomes cohort (2001-2010): patients ≥66 years of age enrolled in Medicare for ≥1 year. We calculated rates of clipping, coiling, and SAH per 100 000 Medicare beneficiaries. We tested for trends in the risk of in-hospital mortality and complications, discharge destination, 30-day mortality, 30-day readmissions, and length of hospitalization.
  
  
  RESULTS
  Characteristics of patients undergoing clipping (n=4357) or coiling (n=7942) did not change appreciably. Overall, 30-day mortality, in-hospital complications, and 30-day readmissions decreased, generally reaching their lowest levels in 2008 to 2010 (1.6%, 25.0%, and 14.5% for clipping and 1.5%, 13.8%, and 11.0% for coiling, respectively). Procedural treatment rates per 100 000 beneficiaries increased from 1.4 in 2000 to 6.0 in 2010, driven mainly by increased use of coiling but SAH rates did not decrease.
  
  
  CONCLUSIONS
  Although outcomes tended to improve over time, increased preventative treatment of unruptured intracranial aneurysms among Medicare beneficiaries did not result in a population-level decrease in SAH rates.
authors.affiliation: From the Departments of Public Health (J.J.J., A.J.I., A.S.) and Neurology and Feil Family Brain and Mind Research Institute (H.K.), Weill Cornell Medical College, New York; and LASER Analytica, New York (J.J.J.). jjj2001@med.cornell.edu.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Jalbert
authors.affiliation: From the Departments of Public Health (J.J.J., A.J.I., A.S.) and Neurology and Feil Family Brain and Mind Research Institute (H.K.), Weill Cornell Medical College, New York; and LASER Analytica, New York (J.J.J.).
authors.forename: Abby J
authors.initials: AJ
authors.lastname: Isaacs
authors.affiliation: From the Departments of Public Health (J.J.J., A.J.I., A.S.) and Neurology and Feil Family Brain and Mind Research Institute (H.K.), Weill Cornell Medical College, New York; and LASER Analytica, New York (J.J.J.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Departments of Public Health (J.J.J., A.J.I., A.S.) and Neurology and Feil Family Brain and Mind Research Institute (H.K.), Weill Cornell Medical College, New York; and LASER Analytica, New York (J.J.J.).
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: aneurysm; medicare; mortality; neurosurgery; subarachnoid hemorrhage