Hoffman Haydn, Jalal Muhammad S, Chin Lawrence S
Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York.
Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104696. doi: 10.1016/j.jstrokecerebrovasdis.2020.104696. Epub 2020 Feb 21.
In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), microsurgical clipping, and endovascular therapy (EVT) with coiling are modalities for securing the ruptured aneurysm. Little data is available regarding associated readmission rates. We sought to determine whether readmission rates differed according to treatment modality for ruptured intracranial aneurysms.
The Nationwide Readmissions Database (NRD) was used to identify adults who experienced aSAH and underwent clipping or EVT. Primary outcomes of interest were the incidences of 30- and 90-day readmissions (30dRA, 90dRA). Propensity score matching was used to generate matched pairs based on age, comorbidities, hospital volume, and hemorrhage severity.
We identified 13,623 and 11,160 patients who were eligible for 30dRA and 90dRA analyses, respectively. Among the patients eligible for 30dRA and 90dRA, we created 4282 and 3518 propensity score-matched pairs, respectively. There was no difference in the incidence of 30dRA (12.4% for clipping versus 11.2% for EVT; P = .094). However, 90dRA occurred more frequently after clipping (22.5%) compared to EVT (19.7%; P = .003). Clipping was associated with poor outcome after 30dRA (odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.21-1.88, P < .001) and after 90dRA (OR = 1.60, 95% CI 1.34-1.91, P = .001). Mean duration to readmission and cost of readmission did not vary, but clipping was associated with longer lengths of stay during readmission.
Microsurgical clipping of ruptured aneurysms is associated with a greater incidence of 90dRA, but not 30dRA, compared to EVT. Poor outcomes after readmission are more common following clipping.
在动脉瘤性蛛网膜下腔出血（aSAH）的治疗中，显微手术夹闭和血管内治疗（EVT）联合弹簧圈栓塞是确保破裂动脉瘤安全的治疗方式。关于相关再入院率的数据很少。我们试图确定破裂颅内动脉瘤的再入院率是否因治疗方式而异。
使用全国再入院数据库（NRD）来识别经历aSAH并接受夹闭或EVT治疗的成年人。主要关注的结局是30天和90天再入院率（30dRA，90dRA）。倾向评分匹配用于根据年龄、合并症、医院规模和出血严重程度生成匹配对。
我们分别确定了13623例和11160例符合30dRA和90dRA分析条件的患者。在符合30dRA和90dRA条件的患者中，我们分别创建了4282对和3518对倾向评分匹配对。30dRA的发生率没有差异（夹闭组为12.4%，EVT组为11.2%；P = 0.094）。然而，与EVT（19.7%）相比（P = 0.003），夹闭后90dRA更频繁发生（22.5%）。夹闭与30dRA后不良结局相关（优势比[OR]=1.51，95%置信区间[CI]1.21 - 1.88，P < 0.001）以及90dRA后（OR = 1.60，95% CI 1.34 - 1.91，P = 0.001）。再入院的平均持续时间和再入院费用没有差异，但夹闭与再入院期间更长的住院时间相关。
与EVT相比，破裂动脉瘤的显微手术夹闭与90dRA的发生率更高相关，但与30dRA无关。夹闭后再入院的不良结局更常见。
