Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005–2009)

Abstract

ObjectivesOur aim was to provide nationwide age-standardised rates (ASR) on the usage of endovascular coiling and neurosurgical clipping for unruptured intracranial aneurysm (UIA) treatment in Germany.SettingNationwide observational study using the Diagnosis-Related-Groups (DRG) statistics for the years 2005–2009 (overall 83 million hospitalisations).ParticipantsFrom 2005 to 2009, overall 39 155 hospitalisations with a diagnosis of UIA occurred in Germany.Primary outcome measuresAge-specific and age-standardised hospitalisation rates for UIA with the midyear population of Germany in 2007 as the standard.ResultsOf the 10 221 hospitalisations with UIA during the observation period, 6098 (59.7%) and 4123 (40.3%) included coiling and clipping, respectively. Overall hospitalisation rates for UIA increased by 39.5% (95% CI 24.7% to 56.0%) and 50.4% (95% CI 39.6% to 62.1%) among men and women, respectively. In 2005, the ASR per 100 000 person years for coiling was 0.7 (95% CI 0.62 to 0.78) for men and 1.7 (95% CI 1.58 to 1.82) for women. In 2009, the ASR was 1.0 (95% CI 0.90 to 1.10) and 2.4 (95% CI 2.24 to 2.56), respectively. Similarly, the ASR for clipping in 2005 amounted to 0.6 (95% CI 0.52 to 0.68) for men and 1.1 (95% CI 1.00 to 1.20) for women. These rates increased in 2009 to 0.8 (95% CI 0.72 to 0.88) and 1.7 (95% CI 1.58 to 1.82), respectively. We observed a marked geographical variation of ASR for coiling and less pronounced for clipping. For the federal state of Saarland, the ASR for coiling was 5.64 (95% CI 4.76 to 6.52) compared with 0.68 (95% CI 0.48 to 0.88; per 100 000 person years) in Saxony-Anhalt, whereas, ASR for clipping were highest in Rhineland-Palatinate (2.48, 95% CI 2.17 to 4.75) and lowest in Saxony-Anhalt (0.52, 95% CI 0.34 to 0.70).ConclusionsTo the best of our knowledge, we presented the first representative, nationwide analysis of the clinical management of UIA in Germany. The ASR increased markedly and showed substantial geographical variation among federal states for all treatment modalities during the observation period.

Surveillance of Unruptured Intracranial Aneurysms

“…Based on estimates retrieved from the literature, we modeled that 46.4% of aneurysms are treated with EVT in the United States, 62.2% in the United Kingdom, and 59.7% in the Netherlands. [13][14][15] Agedependent procedural morbidity rates were used, based on the results from the International Study of Unruptured Intracranial Aneurysms (ISUIA) study. 16 Annual probability of de novo aneurysm formation is larger in the population with known UIAs than in the general population and was found to be 0.97%.…”

Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases

“…34,35 However, this strong trend is not evident from administrative databases of European countries with, in addition, generally longer hospital stays after interventional procedures when compared to US hospitals. 36,37 Because our study reflects data from centers on 4 continents, the cutoff represents a global practice pattern but is not specific to any healthcare system. Nevertheless, it is highly conceivable that the cutoffs presented here can be transferred to national registries (such as National Surgical Quality Improvement Program) 38 in future studies and serve as reference values.…”

The Morphological and Hemodynamic Characteristics of the Intraoperative Ruptured Aneurysm

“…Thus far, microsurgical clipping remains one of the major treatments for intracranial aneurysm (IA), which can effectively prevent an aneurysm from rupturing (Lawton and Vates, 2017; Walendy and Stang, 2017). Intraoperative rupture (IOR) occurs in 2.84–8% of IAs during microsurgical clipping (Farnoush et al, 2013; Lakicevic et al, 2015; Chen et al, 2016).…”