Department of Neurosurgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
Department of Emergency Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
Int J Environ Res Public Health. 2021 Jun 2;18(11):5989. doi: 10.3390/ijerph18115989.
To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling.
From Taiwan's National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence.
The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; < 0.0001).
Medical resource consumption in the coiling group was lower than that in the clipping group.
评估接受手术夹闭或血管内栓塞治疗的蛛网膜下腔出血（SAH）患者的长期医疗资源消耗。
我们从台湾全民健康保险研究数据库中招募了接受夹闭或栓塞治疗的颅内动脉瘤性 SAH 患者。通过倾向评分匹配和混杂因素调整后，使用广义线性混合模型确定动脉瘤性 SAH 的累积住院天数（天）、重症监护病房（ICU）住院天数和总医疗费用的显著差异，以及可能发生的后续手术并发症和复发情况。
匹配过程产生了最终的 8102 例患者队列（血管内线圈栓塞组 4051 例，手术夹闭组 4051 例），他们符合进一步分析的条件。线圈栓塞组（31.2 天）和夹闭组（46.8 天；<0.0001）的累积住院天数存在显著差异。在广义线性模型中，使用对数链接的伽马分布进行调整后，与手术夹闭术相比，血管内线圈栓塞术的累积住院费用医疗成本的调整优势比（aOR；95%置信区间[CI]）为 0.63（0.60，0.66；<0.0001）。线圈栓塞组和夹闭组的累积 ICU 住院时间存在显著差异（9.4 天比 14.9 天；<0.0001）。血管内线圈栓塞组的累积 ICU 住院费用医疗成本的 aOR（95%CI）为 0.61（0.58，0.64；<0.0001）。血管内线圈栓塞组的指数住院总医疗费用的 aOR（95%CI）为 0.85（0.82，0.87；<0.0001）。
血管内线圈栓塞组的医疗资源消耗低于手术夹闭组。
