Vasan Rohit, Patel Jaymin, Sweeney J M, Carpenter Anne Marie, Downes Katheryne, Youssef A Samy, van Loveren Harry, Agazzi Siviero
Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida, Tampa, FL, USA.
Childs Nerv Syst. 2013 Mar;29(3):451-6. doi: 10.1007/s00381-012-1945-z. Epub 2013 Jan 4.
Pediatric intracranial aneurysms constitute a medical disease process with many unique features that present unique challenges in orchestrating their treatment. Conflicts exist in pediatric aneurysm literature as to whether endovascular therapy is equivalent to surgical therapy in assuring durable aneurysm obliteration in this population.
The national Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Dataset was queried using the HCUPnet system. Overall trends in length of stay (LOS), associated charges, and in-hospital deaths were analyzed for both subarachnoid hemorrhage (SAH) and nonruptured aneurysms from 2000 to 2009. Trends in the type of procedure, associated LOS, and charges were analyzed for SAH from 2003 to 2009. A p value <0.05 was considered statistically significant.
Mean LOS for SAH patients was an additional 7-10 days compared to patients discharged with nonruptured aneurysms. Costs of surgery showed a slight increase, while endovascular procedures also rose 50 % from 2006 to 2009. Interestingly, mean length of stay increased for endovascular procedures from 16.5 to 17.2 days and decreased for surgical procedures from 20.4 to 14.7 days (p < 0.001).
First, in-hospital mortality and hospital length of stay for pediatric subarachnoid hemorrhage have not significantly declined since 1997. Second, in-hospital charges for the management of both ruptured and nonruptured aneurysms rose by over 200 % from 2000 to 2009. Surgical procedures saw a 6 % increase in price, while endovascular procedures sharply rose in costs by 50 %. Finally, endovascular therapy has increased in utilization, while the frequency of surgical therapy has not changed significantly since 2003.
小儿颅内动脉瘤是一种具有许多独特特征的医学疾病过程，在安排其治疗时面临独特的挑战。小儿动脉瘤文献中存在关于血管内治疗在确保该人群动脉瘤持久闭塞方面是否等同于手术治疗的争议。
使用HCUPnet系统查询国家医疗保健成本和利用项目（HCUP）儿童住院数据集。分析了2000年至2009年蛛网膜下腔出血（SAH）和未破裂动脉瘤的住院时间（LOS）、相关费用和院内死亡的总体趋势。分析了2003年至2009年SAH的手术类型、相关LOS和费用趋势。p值<0.05被认为具有统计学意义。
与未破裂动脉瘤出院患者相比，SAH患者的平均LOS增加了7 - 10天。手术费用略有增加，而血管内手术从2006年到2009年也上涨了50%。有趣的是，血管内手术的平均住院时间从16.5天增加到17.2天，而手术治疗的住院时间从20.4天减少到14.7天（p < 0.001）。
第一，自1997年以来，小儿蛛网膜下腔出血的院内死亡率和住院时间并未显著下降。第二，2000年至2009年，破裂和未破裂动脉瘤的管理院内费用上涨了200%以上。手术费用上涨了6%，而血管内手术成本急剧上涨了50%。最后，血管内治疗的利用率有所增加，而自2003年以来手术治疗的频率没有显著变化。
