Abstract
Background: Prior studies have suggested that unruptured cerebral aneurysm (CA) treatments have spread from high-volume centers into lower-volume centers in the past decade, coinciding with the increase of endovascular coiling (EC) relative to surgical clipping (SC). Our understanding of outcomes from CA treatments by hospital treatment volumes is lacking. Methods: Using administrative data on all discharges from hospitals in New York (2005-2014) and Florida (2005-2015), we identified patients with treatments for unruptured CAs. Good outcome was defined as discharge home without intracerebral hemorrhage (ICH) and poor outcome as discharge to SNF or death. A composite weighted index of risk factors was calculated using the Charlson Comorbidity Index (CCI). Logistic regression adjusted for age, sex, smoking, diabetes and CCI were performed. Results are provided as median [IQR] or OR [95% CI]. Results: Among 14,064 patients with treated unruptured CAs, median age was 58 [49 - 66] and 75% were female. EC was performed in 9,417 (67%), and increased over time (56% vs. 74%, 2006 vs. 2014). Annual treatments increased over the study period, with 1125 CAs treated in 2006 versus 1517 in 2014, whereas the number of treating hospitals did not (66 vs. 64, 2006 vs. 2014). In adjusted logistic regression, there was no difference in likelihood of a good outcome over time (OR 0.94 [0.86 - 1.03], 2012-2015 vs. 2005 - 2008). The likelihood of good outcome increased with annual hospital treatment volume ( Figure 1a ). This relationship was maintained for patients treated with SC and EC (ORs 1.7 [1.33 - 2.2] and 3.2 [2.5 -4.1]). The likelihood of poor outcome conversely decreased consistently with increasing annual treatment volume ( Figure 1b ). Conclusion: In this large cohort study, we did not observe an increase in the number of hospitals performing CA treatments. However, for patients treated with both SC and EC, treatment at higher-volume centers was associated with improved outcomes.
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