Abstract WMP109: A Third Of Ruptured Aneuryms Are Clipped/coiled Outside High Volume Centers

Abstract

Background: Recent ASA guidelines for the management of aneurysmal SAH (aSAH) patients recommend that low-volume hospitals (<10 aSAH cases/year) should not perform interventions such as clipping and coiling to secure aneurysms, but instead facilitate early transfer to high-volume (>35 aSAH cases/year) hospitals. Using an administrative database, we sought to determine the hospital-level rates of interventional treatment for aSAH patients compared to annual aSAH patient volume in the United States from 2006 to 2010. Methods: This analysis utilized the Premier database, a representative sampling of US hospitals that includes ~15% of hospital discharges. The study period was fiscal years 2006-2010. Cases were defined by primary discharge diagnosis of aSAH (ICD 9 code 430) in patients aged ≥18years. The rates of aneurysmal clipping and coiling were determined by querying the procedure codes 39.51, 39.72, 39.75 and 39.76. The mean annual aSAH volume over the five years by hospital was classified as low (<10), medium (10-35) and high (>35). The Wilcoxon rank sum test was used to test for median differences between groups and chi-square tests for differences in proportion. Results: The proportion of aSAH patients hospitalized at low, medium and high volume hospitals during the study period was 20%, 32% and 48%, respectively. Of all 14,065 cases, 2366 (17%) received clipping and 3070 (22%) received coiling. See table for hospital-level rates of intervention stratified by annual aSAH volume. Conclusion: While many aSAH patients in the United States were hospitalized at high volume hospitals from 2006 to 2010, 34% of clipping and coiling procedures were performed by low- or medium-volume hospitals. Given reports of improved outcomes at higher volume hospitals, efforts should be aimed at transferring aSAH patients from low volume to higher volume hospitals for clipping and coiling procedures.