Comparative effectiveness of ruptured cerebral aneurysm therapies

Propensity score analysis of clipping versus coiling

Jennifer S McDonald, Robert McDonald, J. Fan, David F Kallmes, G. Lanzino, H. J. Cloft

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate.Weevaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. MATERIALS AND METHODS: The Premier Perspective data base was used to identify patients hospitalized between 2006-2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts. RESULTS: A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95% CI, 0.73-1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95% CI, 1.12-1.56]; P = .0006), ischemic complications (OR = 1.51 [95% CI, 1.24 -1.83]; P = .0009), neurologic complications (OR = 1.64 [95% CI, 1.18 -2.27]; P= .0018), and other surgical complications (OR = 1.55 [95% CI, 1.05-2.33]; P = .0240). CONCLUSIONS: This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.

Original languageEnglish (US)
Pages (from-to)164-169
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume35
Issue number1
DOIs
StatePublished - Jan 2014

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Propensity Score
Ruptured Aneurysm
Intracranial Aneurysm
Databases
Hospital Mortality
Morbidity
Therapeutics
Long-Term Care
Nervous System

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Comparative effectiveness of ruptured cerebral aneurysm therapies: Propensity score analysis of clipping versus coiling",
abstract = "BACKGROUND AND PURPOSE: The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate.Weevaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. MATERIALS AND METHODS: The Premier Perspective data base was used to identify patients hospitalized between 2006-2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts. RESULTS: A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27{\%} in 2006 to 21{\%} in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95{\%} CI, 0.73-1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95{\%} CI, 1.12-1.56]; P = .0006), ischemic complications (OR = 1.51 [95{\%} CI, 1.24 -1.83]; P = .0009), neurologic complications (OR = 1.64 [95{\%} CI, 1.18 -2.27]; P= .0018), and other surgical complications (OR = 1.55 [95{\%} CI, 1.05-2.33]; P = .0240). CONCLUSIONS: This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.",
author = "McDonald, {Jennifer S} and Robert McDonald and J. Fan and Kallmes, {David F} and G. Lanzino and Cloft, {H. J.}",
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T2 - Propensity score analysis of clipping versus coiling

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AU - Fan, J.

AU - Kallmes, David F

AU - Lanzino, G.

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N2 - BACKGROUND AND PURPOSE: The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate.Weevaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. MATERIALS AND METHODS: The Premier Perspective data base was used to identify patients hospitalized between 2006-2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts. RESULTS: A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95% CI, 0.73-1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95% CI, 1.12-1.56]; P = .0006), ischemic complications (OR = 1.51 [95% CI, 1.24 -1.83]; P = .0009), neurologic complications (OR = 1.64 [95% CI, 1.18 -2.27]; P= .0018), and other surgical complications (OR = 1.55 [95% CI, 1.05-2.33]; P = .0240). CONCLUSIONS: This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.

AB - BACKGROUND AND PURPOSE: The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate.Weevaluated a national, multihospital patient data base to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. MATERIALS AND METHODS: The Premier Perspective data base was used to identify patients hospitalized between 2006-2011 for ruptured aneurysm who underwent clipping or coiling therapy. A propensity score model, representing the probability of receiving clipping, was generated for each patient by use of relevant patient and hospital variables. After Greedy-type matching of the propensity score, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts. RESULTS: A total of 5229 patients with ruptured aneurysm (1228 clipping, 4001 coiling) treated at 125 hospitals were identified. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. After propensity score adjustment, in-hospital mortality risk was similar between groups (OR = 0.94 [95% CI, 0.73-1.21]; P = .62). However, unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care (OR = 1.32 [95% CI, 1.12-1.56]; P = .0006), ischemic complications (OR = 1.51 [95% CI, 1.24 -1.83]; P = .0009), neurologic complications (OR = 1.64 [95% CI, 1.18 -2.27]; P= .0018), and other surgical complications (OR = 1.55 [95% CI, 1.05-2.33]; P = .0240). CONCLUSIONS: This study of a data base of multiple hospitals in the United States demonstrates that clipping of ruptured cerebral aneurysms resulted in greater adjusted morbidity compared with coiling.

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