Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study.

Yang-Lan Lo,Ming-Chang Li,Szu-Yuan Wu,Ying-Hui Yu,Zen Lang Bih,Ho-Min Chen

doi:10.3390/ijerph18115989

Abstract

Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence. Results: The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; p < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; p < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; p < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; p < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; p < 0.0001). Conclusions: Medical resource consumption in the coiling group was lower than that in the clipping group.

Highlights

The prevalence of intracranial saccular aneurysms, as determined through radiographic and autopsy series, is estimated to be 3.2% in individuals without comorbidities, with a mean age of 50 years, and with a 1:1 gender ratio [1,2,3]
All patients in the endovascular coil embolization group were matched at a 1:1 ratio with patients in the surgical clipping group through propensity score matching (PSM) and global optimization [20]
After PSM, the covariates of age, sex, diagnosis year, aneurysm location, diabetes, congestive heart failure, hypertension, renal diseases, stroke or transient ischemic attack (TIA), Charlson comorbidity index (CCI) score, hospital level, hospital area, and income were observed to be similar in the two cohorts (Table 1)

Summary

Introduction

The prevalence of intracranial saccular aneurysms, as determined through radiographic and autopsy series, is estimated to be 3.2% in individuals without comorbidities, with a mean age of 50 years, and with a 1:1 gender ratio [1,2,3]. Among patients with cerebral aneurysms, 20–30% have multiple aneurysms [4]. Aneurysmal subarachnoid hemorrhage (SAH) occurs in the population at an estimated rate of 6–16 per 100,000 [5]. In. North America, this rate translates into approximately 30,000 cases per year [6]. Most aneurysms, small aneurysms, do not rupture [6,7]. Rupture of an intracranial aneurysm is believed to account for 0.4–0.6% of all deaths [8]. SAH is often a devastating event [9]

Methods

Results

Conclusion