A Propensity Score-Matched Comparison of Readmission Rates Associated With Microsurgical Clipping and Endovascular Treatment of Ruptured Intracranial Aneurysms |
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| Affiliation: | 2. University of Texas Southwestern Medical Center, Department of Neurological Surgery and Neurology and Neurotherapeutics, Dallas, Texas;3. University of Texas Health Science Center School of Public Health, Department of Biostatistics and Data Science, Dallas, Texas;2. Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina;2. College of medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia;3. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;4. Almaarrefa University, Ad Diriyah, Saudi Arabia;2. Faculty of Medicine, McGill University, Montreal, Quebec, Canada;3. Department of Medicine (Neurology), Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada;2. University Hospital in Krakow, Poland;3. Jagiellonian University Medical College, Department of Radiology, Krakow, Poland;4. Jagiellonian University Medical College, Department of Pharmacology, Krakow, Poland;5. John Paul II Hospital, Krakow, Poland;6. Faculty of Medicine, University of Rzeszow, Poland |
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| Abstract: | Background: In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), microsurgical clipping, and endovascular therapy (EVT) with coiling are modalities for securing the ruptured aneurysm. Little data is available regarding associated readmission rates. We sought to determine whether readmission rates differed according to treatment modality for ruptured intracranial aneurysms. Methods: The Nationwide Readmissions Database (NRD) was used to identify adults who experienced aSAH and underwent clipping or EVT. Primary outcomes of interest were the incidences of 30- and 90-day readmissions (30dRA, 90dRA). Propensity score matching was used to generate matched pairs based on age, comorbidities, hospital volume, and hemorrhage severity. Results: We identified 13,623 and 11,160 patients who were eligible for 30dRA and 90dRA analyses, respectively. Among the patients eligible for 30dRA and 90dRA, we created 4282 and 3518 propensity score-matched pairs, respectively. There was no difference in the incidence of 30dRA (12.4% for clipping versus 11.2% for EVT; P = .094). However, 90dRA occurred more frequently after clipping (22.5%) compared to EVT (19.7%; P = .003). Clipping was associated with poor outcome after 30dRA (odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.21-1.88, P < .001) and after 90dRA (OR = 1.60, 95% CI 1.34-1.91, P = .001). Mean duration to readmission and cost of readmission did not vary, but clipping was associated with longer lengths of stay during readmission. Conclusions: Microsurgical clipping of ruptured aneurysms is associated with a greater incidence of 90dRA, but not 30dRA, compared to EVT. Poor outcomes after readmission are more common following clipping. |
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