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PLoS One. 2015 Sep 11;10(9):e0137946. doi: 10.1371/journal.pone.0137946. eCollection 2015.

Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

Author information

1
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
2
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, United States of America.
3
Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
4
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America; Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America.

Abstract

OBJECT:

Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH) patients in a real-world regional cohort.

METHODS:

We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.

RESULTS:

Of the 4,098 patients undergoing treatment, 2,585 (63.1%) underwent coiling, and 1,513 (36.9%) underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME), -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS) (ME, 1.72; 95% CI, -3.39 to 6.84), or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22) between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01). In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.

CONCLUSIONS:

Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

PMID:
26360422
PMCID:
PMC4567333
DOI:
10.1371/journal.pone.0137946
[Indexed for MEDLINE]
Free PMC Article

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