National trends in cerebral bypass for unruptured intracranial aneurysms: a National (Nationwide) Inpatient Sample analysis of 1998–2015

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors extracted data from the NIS database for the years 1998–2015 using the ICD-9/10 diagnostic and procedure codes. Patients with a primary diagnosis of UIA with a concurrent bypass procedure were included in the study. Outcomes and hospital charges were analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 216,212 patients had a primary diagnosis of UIA during the study period. The number of patients diagnosed with a UIA increased by 128% from 1998 (n = 7718) to 2015 (n = 17,600). Only 1328 of the UIA patients (0.6%) underwent cerebral bypass. The percentage of patients who underwent bypass in the flow diverter era (2010–2015) remained stable at 0.4%. Most patients who underwent bypass were white (51%), were female (62%), had a median household income in the 3rd or 4th quartiles (57%), and had private insurance (51%). The West (33%) and Midwest/North Central regions (30%) had the highest volume of bypasses, whereas the Northeast region had the lowest (15%). Compared to the period 1998–2011, bypass procedures for UIAs in 2012–2015 shifted entirely to urban teaching hospitals (100%) and to an elective basis (77%). The median hospital stay (9 vs 3 days, p &lt; 0.0001), median hospital charges ($186,746 vs $66,361, p &lt; 0.0001), and rate of any complication (51% vs 17%, p &lt; 0.0001) were approximately threefold higher for the UIA patients with bypass than for those without bypass.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Despite a significant increase in the diagnosis of UIAs over the 17-year study period, the proportion of bypass procedures performed as part of their treatment has remained stable. Therefore, advances in endovascular aneurysm therapy do not appear to have affected the volume of bypass procedures performed in the UIA population. The authors’ findings suggest a potentially ongoing niche for bypass procedures in the contemporary treatment of UIAs.</jats:p></jats:sec>

Association of Periodontal Disease with the Occurrence of Unruptured Cerebral Aneurysm among Adults in Korea: A Nationwide Population-Based Cohort Study

“…Although we applied a one-year washout period before the index date, the possibility of a hidden unruptured cerebral aneurysm at baseline still remains, and under-reporting might have been possible. However, some previous reports used a definition for the presence of unruptured cerebral aneurysms similar to the method used in our study [ 26 , 27 ]. Nevertheless, there was a paucity of events with a low aneurysm rate, which decreased the significance of our results.…”

Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory

“…1,2 Bypass surgery remains a useful tool for complex aneurysms requiring revascularization, but it is a rare procedure utilized in only approximately 0.4% of cases across the United States. 16 The current guidelines for resident education hours and competition among tertiary centers 3 contribute to the shrinking microsurgical operative training exposure for residents. 17…”

Demographics and Outcomes of Spine Surgery in Octogenarians and Nonagenarians: A Comparison of the National Inpatient Sample, MarketScan and National Surgical Quality Improvement Program Databases

“…Incorporation of national databases into research has substantially increased in the past few years [2,3,6,13,14]. Although these large sample sizes offer researchers opportunities to investigate rare diseases, the statistically significant results are nevertheless susceptible to type I errors, or false-positive results [1].…”

“…Truven Health Analytics MarketScan® database compiles its samples from claims of employees, Medicare-eligible retirees, early retired, Consolidated Omnibus Budget Reconciliation Act (COBRA) participants and their dependents enrolled through large US corporations in the private sector [9,21]. In contrast, HCUP NIS collects a stratified systematic sample from all HCUP hospitals, which is equivalent to 20% of all discharges from community hospitals in the United States [10,14]. Based on the method used to collect the cohort sample, NIS is most likely representative of national means and the US population.…”