Epidemiological Comparison between Microsurgery and Embolization of Aneurysms in Brazil from 2010 to 2015

Abstract

Introduction: Intracerebral Aneurysms are important causes of morbidity and mortality, with mortality rate of up to 50%. Endovascular coiling was introduced as an alternative to surgical clipping, and has shown better results with a reduction in morbidity and mortality risk of 6-9%. Objective: To characterize the two types of treatment for intracerebral aneurysms within Brazilian scenario, and to compare the results with the international literature. Methods: An analytic observational study using data from the SIH / DATASUS (National Health Information System) in the period of 2010-2015. Results: The total number of hospitalizations decreased, with a 38.3% decrease in clipping and 18.4% in embolizations. The mean value of embolization was significantly higher, however, presenting a downward trend (R$ 22,011.37 in 2010 to R$ 15,607.18 in 2015), while the value of microsurgery increased (R$ 7,022.31 to R$ 8,645.28, respectively). Microsurgery was a risk factor for death (p-value <0.01). Conclusion: It has been shown that the international trend of transition from clipping to embolization did not occur in Brazil. The cost of embolization is much higher. For the authors, the death outcome contrasts with literature due to confounding factors that act within limitations of the study.