Department of Neurological Surgery, University of Florida, Gainesville, Fla 32610, USA.
Stroke. 2010 Feb;41(2):337-42. doi: 10.1161/STROKEAHA.109.569269. Epub 2009 Dec 31.
We have previously reported the difference in length of stay and hospital charges for patients with cerebral aneurysms treated with either clipping or coiling at our institution. We now report an analysis of the same comparison at a national level conducted using the Nationwide Inpatient Sample database.
We obtained the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project, Agency for Healthcare Quality and Research. The Nationwide Inpatient Sample is the largest all-payer inpatient care database in the US and represents approximately 20% of all inpatient admissions to US nonfederal hospitals. Hospitalizations for clipping or coiling of ruptured and unruptured cerebral aneurysms from 2002 to 2006 were identified by cross-matching International Classification of Diseases-9 codes for diagnoses of subarachnoid hemorrhage (430) or unruptured cerebral aneurysm (437.3) with procedure codes for clipping (39.51) or coiling (39.79, 39.72, or 39.52) of cerebral aneurysms. Length of hospital stay and total hospital charges for clipping and coiling were compared using linear mixed models adjusted for the following patient and hospital-specific factors: gender, age, race/ethnicity, admission source and type, median income level in patient's postal code of residence, payer for care, comorbidities, and hospital cerebral aneurysm case volume, bed size, teaching status, rural/urban location, and geographic region.
There were 9635 hospitalizations for ruptured aneurysm treatments (6019 clipping, 3616 coiling) and 9399 hospitalizations for unruptured aneurysm treatments (4700 clipping, 4699 coiling). For ruptured aneurysm patients, after adjusting for the effects of patient-specific and hospital-specific factors, clipping compared to coiling was associated with significantly longer length of stay (P<0.0001) and significantly higher total hospital charges (P<0.0001). For unruptured aneurysm patients, clipping compared to coiling was associated with significantly longer length of stay (P<0.0001) and significantly higher total hospital charges (P<0.0001). After adjusting for the effects of hospital-level and patient-level characteristics, clipping as compared to coiling was associated with an average of 1.2-times more days in hospitalization for ruptured patients and was associated with an average of 1.8-times more days in hospitalization for unruptured patients. On average, clipping resulted in $15,325 more in total charge for ruptured patients and resulted in $11,263 more in total charge for unruptured patients after considering all relevant hospital and patient characteristics.
The results of this nationwide analysis differed from the findings of our single institution study. Clipping compared to coiling was associated with significantly longer lengths of stay and significantly higher total hospital charges for both ruptured and unruptured aneurysm patients.
我们之前报道过，在我们机构中，接受夹闭术或血管内栓塞术治疗的颅内动脉瘤患者的住院时间和住院费用存在差异。现在，我们使用全美住院患者样本数据库（Nationwide Inpatient Sample database）对全国范围内的同一比较进行了分析。
我们从医疗保健成本和利用项目（Agency for Healthcare Quality and Research）的全美住院患者样本（Nationwide Inpatient Sample）中获取数据。全美住院患者样本是美国最大的所有支付者住院治疗数据库，代表了美国非联邦医院约 20%的住院人数。通过交叉匹配国际疾病分类第 9 版（International Classification of Diseases-9）诊断亚急性蛛网膜下腔出血（430）或未破裂颅内动脉瘤（437.3）的代码与夹闭（39.51）或血管内栓塞术（39.79、39.72 或 39.52）的手术代码，确定 2002 年至 2006 年夹闭或血管内栓塞术治疗破裂和未破裂颅内动脉瘤的住院情况。使用线性混合模型比较夹闭和血管内栓塞术的住院时间和总住院费用，并根据以下患者和医院特定因素进行调整：性别、年龄、种族/民族、入院来源和类型、患者居住地邮政编码的中位数收入水平、支付者、合并症以及医院颅内动脉瘤病例量、床位数、教学地位、城乡位置和地理位置。
共有 9635 例破裂性动脉瘤治疗（6019 例夹闭术，3616 例血管内栓塞术）和 9399 例未破裂性动脉瘤治疗（4700 例夹闭术，4699 例血管内栓塞术）。对于破裂性动脉瘤患者，在调整患者特定和医院特定因素的影响后，夹闭与血管内栓塞术相比，其住院时间明显延长（P<0.0001），总住院费用明显增加（P<0.0001）。对于未破裂性动脉瘤患者，夹闭与血管内栓塞术相比，其住院时间明显延长（P<0.0001），总住院费用明显增加（P<0.0001）。在调整医院和患者特征的影响后，与血管内栓塞术相比，夹闭术与破裂性动脉瘤患者的平均住院时间延长 1.2 倍，与未破裂性动脉瘤患者的平均住院时间延长 1.8 倍。平均而言，考虑到所有相关的医院和患者特征，夹闭术与破裂性动脉瘤患者的总费用增加 15325 美元，与未破裂性动脉瘤患者的总费用增加 11263 美元。
这项全国性分析的结果与我们单机构研究的结果不同。与血管内栓塞术相比，夹闭术与破裂性和未破裂性动脉瘤患者的住院时间延长和总住院费用增加均显著相关。
