Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
J Neurointerv Surg. 2014 Jun;6(5):349-52. doi: 10.1136/neurintsurg-2013-010811. Epub 2013 Jun 8.
A recent expansion of the neurointerventional workforce in the USA could lead to a trend toward cerebral aneurysms being increasingly treated at low volume centers. Such a trend could have a negative impact on patient care as higher volume centers are known to have better outcomes.
Using the Nationwide Inpatient Sample, we evaluated trends in aneurysm treatment in the USA from 2001 to 2010. Annual volumes of both ruptured and unruptured aneurysms were counted, as well as annual percentages of cases treated at high volume centers (≥50 aneurysms/year clipped or coiled).
The number of ruptured aneurysms treated per year has fluctuated between 9000 and 12 000 from 2003 to 2010. In 2001-2002, 27.4% of intracranial aneurysm patients were treated with clipping or coiling at high volume centers, with a peak of 70.1% in 2007-2008. This proportion dropped to 61.8% in 2009-2010. The proportion of patients clipped at high volume centers was 23.3% in 2001-2002 and peaked at 65.0% in 2007-2008. In 2009-2010, the proportion dropped to 58.6%. For coiling patients, 46.4% were treated at high volume centers in 2001-2002, with a peak of 70.1% in 2007-2008, and a drop to 61.8% in 2009-2010.
A trend toward less cerebral aneurysms being treated in high volume centers in 2009 and 2010 is worrisome because high volume centers are known to tend to have better outcomes. This trend is likely due to recent expansion of the neurointerventional workforce.
美国神经介入专业人员数量的最近扩张可能导致趋势是，越来越多的脑动脉瘤在低容量中心得到治疗。由于高容量中心的结果已知更好，这种趋势可能对患者护理产生负面影响。
使用全国住院患者样本，我们评估了 2001 年至 2010 年美国动脉瘤治疗的趋势。计算了破裂和未破裂动脉瘤的年治疗量，以及每年在高容量中心（每年夹闭或栓塞≥50 个动脉瘤）治疗的病例百分比。
从 2003 年至 2010 年，每年治疗的破裂性动脉瘤数量在 9000 至 12000 个之间波动。在 2001-2002 年，70.1%的颅内动脉瘤患者在高容量中心接受夹闭或栓塞治疗，2007-2008 年达到峰值。这一比例在 2009-2010 年降至 61.8%。在高容量中心夹闭的患者比例在 2001-2002 年为 23.3%，在 2007-2008 年达到峰值 65.0%。在 2009-2010 年，这一比例降至 58.6%。对于接受栓塞治疗的患者，在 2001-2002 年有 46.4%在高容量中心接受治疗，2007-2008 年达到峰值 70.1%，在 2009-2010 年降至 61.8%。
2009 年和 2010 年，在高容量中心治疗的脑动脉瘤数量呈下降趋势令人担忧，因为高容量中心的结果已知更好。这种趋势可能是由于神经介入专业人员数量的最近扩张。
