Abstract
Autosomal dominant polycystic kidney disease is associated with an increased risk of intracranial aneurysms. Our purpose was to assess whether there is an increased risk during aneurysm coiling and clipping. Data were obtained from the National Inpatient Sample (2000-2011). All subjects had an unruptured aneurysm clipped or coiled and were divided into polycystic kidney (n = 189) and control (n = 3555) groups. Primary end points included in-hospital mortality, length of stay, and total hospital charges. Secondary end points included the International Classification of Diseases, Ninth Revision codes for iatrogenic hemorrhage or infarction; intracranial hemorrhage; embolic infarction; and carotid and vertebral artery dissections. There was a significantly greater incidence of iatrogenic hemorrhage or infarction, embolic infarction, and carotid artery dissection in the patients with polycystic kidney disease compared with the control group after endovascular coiling. There was also a significantly greater incidence of iatrogenic hemorrhage or infarction in the polycystic kidney group after surgical clipping. However, the hospital stay was not longer in the polycystic kidney group, and the total hospital charges were not higher. Additional analysis within the polycystic kidney group revealed a significantly shorter length of stay but similar in-hospital costs when subjects underwent coiling versus clipping. Patients with polycystic kidney disease face an increased risk during intracranial aneurysm treatment, whether by coiling or clipping. This risk, however, does not translate into longer hospital stays or increased hospital costs. Despite the additional catheterization-related risks of dissection and embolization, coiling results in shorter hospital stays and similar mortality compared with clipping.
Highlights
BACKGROUND AND PURPOSEAutosomal dominant polycystic kidney disease is associated with an increased risk of intracranial aneurysms
There was a significantly greater incidence of iatrogenic hemorrhage or infarction, embolic infarction, and carotid artery dissection in the patients with polycystic kidney disease compared with the control group after endovascular coiling
Additional analysis within the polycystic kidney group revealed a significantly shorter length of stay but similar in-hospital costs when subjects underwent coiling versus clipping
Summary
The ADPCKD group had a diagnosis of “polycystic kidney disease, autosomal dominant” (ICD9-CM code 753.13), while the control group did not. Patients with a diagnosis of “subarachnoid hemorrhage” (ICD9-CM code 430) were excluded from this study as in prior similar investigations due to the concern of potential coding errors and patients with ruptured intracranial aneurysms being included in our study. Primary end points investigated in this study included in-hospital mortality, length of stay, and total hospital charges. Secondary end points included the diagnoses “iatrogenic cerebrovascular hemorrhage or infarction” (ICD9-CM code 997.02), “intracerebral hemorrhage” (ICD9-CM code 431), “unspecified intracranial hemorrhage” (ICD9-CM code 432.9), “cerebral embolism. The NIS data were imported into SPSS (IBM, Armonk, New York), and searches were performed by using scripts containing the above codes. Statistical analyses of the data were performed by using 2 for categoric variables and t test for continuous variables
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