title: The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms.
abstract: OBJECTIVE The impact of combined practices on the outcomes of unruptured cerebral aneurysm coiling remains an issue of debate. The authors investigated the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm coiling. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent endovascular coiling for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding, the authors used propensity score conditioning, with mixed effects to account for clustering at the hospital referral region level. RESULTS During the study period, there were 11,716 patients who underwent endovascular coiling for unruptured cerebral aneurysms and met the inclusion criteria. Of these, 1186 (10.1%) underwent treatment performed by hybrid neurosurgeons, and 10,530 (89.9%) by proceduralists who performed only endovascular coiling. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR 0.84; 95% CI 0.58-1.23), discharge to rehabilitation (OR 1.0; 95% CI 0.66-1.51), 30-day readmission rate (OR 1.07; 95% CI 0.83-1.38), and length of stay (adjusted difference, 0.41; 95% CI -0.26 to 1.09). Higher procedural volume was independently associated with improved outcomes. CONCLUSIONS In a cohort of Medicare patients, the authors did not demonstrate a difference in mortality, discharge to rehabilitation, readmission rate, and LOS between hybrid neurosurgeons and proceduralists performing only endovascular coiling.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Dan
authors.initials: D
authors.lastname: Gottlieb
authors.affiliation: Department of Radiology, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Yin
authors.initials: Y
authors.lastname: Su
authors.affiliation: Department of Neurosurgery, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.|Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover.|Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon; and.|Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D006278:Medicare; D000069471:Neurosurgeons; D010359:Patient Readmission; D013038:Specialization; D016896:Treatment Outcome; D014481:United States
keywords: COPD = chronic obstructive pulmonary disease; LOS = length of stay; Medicare; cerebral aneurysms; elderly; endovascular surgery; hybrid neurosurgeons; interventional neurosurgery; vascular disorders