Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database
Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database
复制标题
DOI：
10.3171/jns/2008/108/6/1163
复制
发表时间：
2008-06-01
影响因子：
4.1
通讯作者：
Zuccarello, Mario
中科院分区：
文献类型：
--
作者：
Andaluz, Norberto;Zuccarello, Mario
Object.对于破裂和未破裂的脑动脉瘤，最合适的治疗方法目前仍在讨论中，更新的指南尚未确定。作者试图确定美国脑动脉瘤治疗的趋势以及结局。作者回顾性分析了1993-2003年期间全国住院患者样本出院数据库（医疗保健研究和质量机构医疗保健成本和利用项目）的数据。对多个变量进行分类，并对国际疾病分类第9次修订版、与蛛网膜下腔出血（SAH）、未破裂动脉瘤、脑血管瘤夹闭和血管内治疗相关的临床修改代码进行统计学分析。在研究期间，SAH的放电次数保持稳定，但未破裂动脉瘤的放电次数增加了一倍。同时，采用金属夹置入术治疗的动脉瘤数量保持稳定，通过血管内手术治疗的数量翻了一番。到研究结束时，SAH的死亡率下降了20%，未破裂动脉瘤的死亡率下降了50%。年龄的增加与死亡率、平均住院时间和平均费用的增加相关（p < 0.01）。血管内治疗在老年患者中更常见（p < 0.01）。教学状况和较大的医院规模与较高的费用和较长的住院时间相关（尽管相关性没有统计学意义），并且与较好的结局（p < 0.05）和较低的死亡率（p < 0.05）相关，特别是在接受动脉瘤夹闭术的患者中（p < 0.01）。血管内治疗与小医院的死亡率显著升高（p < 0.001）和发病率稳步上升（45%）相关。动脉瘤夹闭术组的死亡率、平均LOS和平均费用均高于动脉瘤夹闭术组（p < 0.01）。从1993年到2003年，动脉瘤闭塞的血管内技术得到越来越多的使用，而外科夹闭术的使用保持稳定。在研究期结束时，观察到治疗脑动脉瘤（包括破裂和未破裂）的总体结局更好。大型学术中心与更好的结果相关，特别是在手术夹放置方面。
Object. The most appropriate treatment for cerebral aneurysms, both ruptured and unruptured, is currently under debate, and updated guidelines have yet to be defined. The authors attempted to identify trends in therapy for cerebral aneurysms in the US as well as outcomes.Methods. The authors retrospectively reviewed data from the Nationwide Inpatient Sample hospital discharge database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) for the period 1993-2003. Multiple variables were categorized and subjected to statistical analysis for International Classification of Diseases, 9th Revision, Clinical Modification codes related to subarachnoid hemorrhage (SAH), unruptured aneurysm, and clipping and endovascular treatment of cerebral aneurysm.Results. During the study period, the numbers of discharges remained stable for SAH but doubled for unruptured aneurysms. Concomitantly, the number of aneurysms treated with clip placement remained stable, and the number treated by means of endovascular procedures doubled. By the study's end, the mortality rates had decreased 20% for SAH and 50% for unruptured aneurysms. Increasing age was associated with increased mortality rates, mean length of hospital stay (LOS), and mean charges (p < 0.01). Endovascular treatment was used more often in older patients (p < 0.01). Teaching status and larger hospital size were associated with higher charges and longer hospital stays (although the association was not statistically significant) and with better outcomes (p < 0.05) and lower mortality rates (p < 0.05), especially in patients who underwent aneurysm clipping (p < 0.01). Endovascular treatment was associated with significantly higher mortality rates in small hospitals (p < 0.001) and steadily increasing morbidity rates (45%). Morbidity rates, mean LOS, and mean charges were higher for aneurysm clipping (p < 0.01).Conclusions. From 1993 to 2003, endovascular techniques for aneurysm occlusion have been increasingly used, while the use of surgical clipping procedures has remained stable. Toward the end of the study period, better overall outcomes were observed in the treatment of cerebral aneurysms, both ruptured and unruptured. Large academic centers were associated with better results, particularly for surgical clip placement.