Park Yung Ki, Yoon Byul-Hee, Hwang Eui-Hyun, Kim Jae Hoon, Kang Hee In, Won Yu Deok, Cheong Jin Whan
Department of Neurosurgery, Uijeongbu Eulji Medical Center, Gyeonggi-do, Korea.
Department of Neurosurgery, Nowon Eulji Medical Center, Seoul, Korea.
J Cerebrovasc Endovasc Neurosurg. 2025 Mar;27(1):19-32. doi: 10.7461/jcen.2024.E2024.08.005. Epub 2024 Nov 29.
In this study, changes in treatment methods and patient prognosis were analyzed using a Korean nationwide medical insurance information database.
Patients with subarachnoid hemorrhage who received surgical treatment for cerebral aneurysm from 2005 to 2020 were included. The specific surgery type was classified using the surgical code and according to whether stents were used. Yearly trends in mortality rates and poor prognosis, using tracheostomy as proxy, were analyzed by a simple regression analysis. A multistep logistic regression analysis was performed to evaluate the risk factors of mortality and poor prognosis.
Overall, 83,587 patients were included. Females were predominant (64.5%). Microsurgical clip usage rate decreased by approximately two-thirds from 78.8% in 2005 to 24.4% in 2020. Contrarily, endovascular treatment proportion gradually increased, and stent-assisted coil embolization rate surpassed microsurgical clip usage rate in 2020 (24.6% vs. 24.4%). In the multivariate analysis, endovascular treatment correlated positively with 3-month mortality (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 1.07-1.19, P<0.0001), although correlated negatively with poor prognosis (tracheostomy) (HR: 0.93, 95% CI: 0.89-0.98, P=0.0050).
According to the treatment trend analysis, during the 16 years studied, for patients with subarachnoid hemorrhage due to ruptured cerebral aneurysm, the endovascular treatment rate increased rapidly and stent-assisted coil embolization rate surpassed that of microsurgical clip ligation. Diversification of treatment methods has led to a decrease in mortality and improved prognosis.
本研究利用韩国全国医疗保险信息数据库分析治疗方法的变化及患者预后情况。
纳入2005年至2020年接受脑动脉瘤手术治疗的蛛网膜下腔出血患者。根据手术编码及是否使用支架对具体手术类型进行分类。通过简单回归分析，分析以气管切开术为代表的死亡率和预后不良的年度趋势。进行多步逻辑回归分析以评估死亡和预后不良的危险因素。
共纳入83587例患者。女性占主导（64.5%）。显微外科夹闭使用率从2005年的78.8%下降了约三分之二，至2020年为24.4%。相反，血管内治疗比例逐渐增加，2020年支架辅助弹簧圈栓塞率超过了显微外科夹闭使用率（24.6%对24.4%）。在多变量分析中，血管内治疗与3个月死亡率呈正相关（风险比[HR]：1.13，95%置信区间[CI]：1.07 - 1.19，P<0.0001），尽管与预后不良（气管切开术）呈负相关（HR：0.93，95%CI：0.89 - 0.98，P = 0.0050）。
根据治疗趋势分析，在研究的16年中，对于因脑动脉瘤破裂导致蛛网膜下腔出血的患者，血管内治疗率迅速上升，支架辅助弹簧圈栓塞率超过了显微外科夹闭术。治疗方法的多样化导致了死亡率的降低和预后的改善。
