Pediatric intracranial aneurysms: current national trends in patient management and treatment

Abstract

Pediatric intracranial aneurysms constitute a medical disease process with many unique features that present unique challenges in orchestrating their treatment. Conflicts exist in pediatric aneurysm literature as to whether endovascular therapy is equivalent to surgical therapy in assuring durable aneurysm obliteration in this population. The national Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Dataset was queried using the HCUPnet system. Overall trends in length of stay (LOS), associated charges, and in-hospital deaths were analyzed for both subarachnoid hemorrhage (SAH) and nonruptured aneurysms from 2000 to 2009. Trends in the type of procedure, associated LOS, and charges were analyzed for SAH from 2003 to 2009. A p value <0.05 was considered statistically significant. Mean LOS for SAH patients was an additional 7-10days compared to patients discharged with nonruptured aneurysms. Costs of surgery showed a slight increase, while endovascular procedures also rose 50% from 2006 to 2009. Interestingly, mean length of stay increased for endovascular procedures from 16.5 to 17.2days and decreased for surgical procedures from 20.4 to 14.7days (p < 0.001). First, in-hospital mortality and hospital length of stay for pediatric subarachnoid hemorrhage have not significantly declined since 1997. Second, in-hospital charges for the management of both ruptured and nonruptured aneurysms rose by over 200% from 2000 to 2009. Surgical procedures saw a 6% increase in price, while endovascular procedures sharply rose in costs by 50%. Finally, endovascular therapy has increased in utilization, while the frequency of surgical therapy has not changed significantly since 2003.