Incidence of Seizures or Epilepsy After Clipping or Coiling of Ruptured and Unruptured Cerebral Aneurysms in the Nationwide Inpatient Sample Database: 2002-2007

Hoh, Brian L.; Nathoo, Sunina; Chi, Yueh‐Yun; Mocco, J; Barker, Fred G.

doi:10.1227/neu.0b013e31821bc46d

Cited by 54 publications

(25 citation statements)

References 30 publications

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“…[3][4][5][6][7] However, our study offers substantial advances compared with these previous studies. First, we performed propensity score adjustment using numerous patient and hospital covariates to better match clipping and coiling patients and minimize selection bias, and we performed a sensitivity analysis to measure the effect of a possible unmeasured confounder.…”

Section: Discussionmentioning

confidence: 94%

“…Previously published large patient database studies have demonstrated that patients who underwent clipping for unruptured aneurysms had worse outcomes compared with patients who underwent coiling. [3][4][5][6][7] However, these retrospective studies may have been affected by selection bias, because patients were not randomized to clipping or coiling. To address this concern of selection bias, we performed a propensity score analysis of patients treated with clipping or coiling of unruptured aneurysms between 2006 and 2011 to assess for disparities in periprocedural outcomes between these 2 treatment modalities.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

McDonald

Fan

et al. 2013

Stroke

105

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Background and Purpose-Endovascular therapy has increasingly become the most common treatment for unruptured cerebral aneurysms in the United States. We evaluated a national, multi-hospital database to examine recent utilization trends and compare periprocedural outcomes between clipping and coiling treatments of unruptured aneurysms. Methods-The Premier Perspective database was used to identify patients hospitalized between 2006 to 2011 for unruptured cerebral aneurysm who underwent clipping or coiling therapy. A logistic propensity score was generated for each patient using relevant patient, procedure, and hospital variables, representing the probability of receiving clipping. Covariate balance was assessed using conditional logistic regression. Following propensity score adjustment using 1:1 matching methods, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

McDonald

Fan

et al. 2013

Stroke

105

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“…215,216 In terms of specific complications after UIA surgery, the rate of seizure after craniotomy for UIA is poorly defined. Analyses of administrative data sets have reported a very low incidence of 0.1% for status epilepticus 199 and as high as 9.2% when reporting any seizures, 217 although these studies do not account for preexisting seizures or use of anticonvulsant drugs. For example, in the ISUIA cohort, 4.4% of patients with surgically treated UIAs had a preexisting convulsive disorder.…”

Section: Surgical Clipping Outcomesmentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

834

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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“…Further, most of the studies have been retrospective analyses of single-institution experiences, 10 demonstrating results with limited generalization given their inherent selection bias. The interpretation of other multicenter studies is equally limited given their focus on specific subgroup data 1,2,4,5,7,8 or their consideration of all morbidity as one variable. 3,15 The Nationwide Inpatient Sample (NIS) is a hospital discharge database that represents approximately 20% of all inpatient admissions to nonfederal hospitals in the US.…”

mentioning

confidence: 99%

Predicting inpatient complications from cerebral aneurysm clipping: the Nationwide Inpatient Sample 2005–2009

Bekelis¹,

Missios

MacKenzie³

et al. 2014

JNS

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Object. Precise delineation of individualized risks of morbidity and mortality is crucial in decision making in cerebrovascular neurosurgery. The authors attempted to create a predictive model of complications in patients undergoing cerebral aneurysm clipping (CAC).Methods. The authors performed a retrospective cohort study of patients who had undergone CAC in the period from 2005 to 2009 and were registered in the Nationwide Inpatient Sample (NIS) database. A model for outcome prediction based on preoperative individual patient characteristics was developed.Results. Of the 7651 patients in the NIS who underwent CAC, 3682 (48.1%) had presented with unruptured aneurysms and 3969 (51.9%) with subarachnoid hemorrhage. The respective inpatient postoperative risks for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure were 0.7%, 15.3%, 5.3%, 1.5%, 1.3%, 0.6%, 2.0%, and 0.1% for those with unruptured aneurysms and 11.5%, 52.8%, 5.5%, 39.2%, 1.7%, 2.8%, 2.7%, and 0.8% for those with ruptured aneurysms. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated using the area under the receiver operating characteristic curve, and it was found to have good discrimination.Conclusions. The featured model can provide individualized estimates of the risks of postoperative complications based on preoperative conditions and can potentially be used as an adjunct in decision making in cerebrovascular neurosurgery. 591Abbreviations used in this paper: ARF = acute renal failure; AVM = arteriovenous malformation; CAC = cerebral aneurysm clipping; CAD = coronary artery disease; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CRF = chronic renal failure; DVT = deep vein thrombosis; NIS = Nationwide Inpatient Sample; PE = pulmonary embolism; PVD = peripheral vascular disease; SAH = subarachnoid hemorrhage; SE = standard error.* Drs. Bekelis and Missios contributed equally to this work.This article contains some figures that are displayed in color on line but in black-and-white in the print edition. Cohort DefinitionTo establish the study cohort, we used ICD-9-CM codes to identify patients in the registry who had undergone clipping (ICD-9-CM code 39. Independent and Outcome VariablesThe primary outcome variables (Table 1) were the inpatient postoperative risks of stroke, cardiac complications, death, treated hydrocephalus, DVT, PE, ARF, length of hospital stay more than 4 days for patients with unruptured aneurysms, length of hospital stay more than 14 days for patients with ruptured aneurysms, and unfavorable discharge (transfer to short-term hospital, skilled nursing facility, intermediate care, or rehabilitation center). The effect of pertinent exposure variables on outcomes was examined in a multivariate analysis. Age was the on...

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Incidence of Seizures or Epilepsy After Clipping or Coiling of Ruptured and Unruptured Cerebral Aneurysms in the Nationwide Inpatient Sample Database: 2002-2007

Abstract: In unruptured cerebral aneurysm patients, clipping is associated with a higher risk of seizures or epilepsy.

Cited by 54 publications

References 30 publications

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Predicting inpatient complications from cerebral aneurysm clipping: the Nationwide Inpatient Sample 2005–2009

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