Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping

Silva, Nicole A.; Shao, Belinda; Sylvester, Michael; Eloy, Jean Anderson; Gandhi, Chirag D.

doi:10.3171/2018.1.focus17714

Cited by 34 publications

(30 citation statements)

References 33 publications

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“…Until now, no study has examined long-term total comprehensive medical resource consumption between coiling and clipping for low-grade aneurysmal SAH. Some studies have compared hospital stay, ICU stay, or medical cost between coiling and clipping for unruptured intracranial aneurysms [ 27 , 28 , 29 , 30 , 31 , 32 ]. In patients with unruptured intracranial aneurysms, findings regarding total index hospitalization costs for clipping or coiling have been controversial [ 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have compared hospital stay, ICU stay, or medical cost between coiling and clipping for unruptured intracranial aneurysms [ 27 , 28 , 29 , 30 , 31 , 32 ]. In patients with unruptured intracranial aneurysms, findings regarding total index hospitalization costs for clipping or coiling have been controversial [ 27 , 28 , 29 , 30 , 31 , 32 ]. No solid conclusions regarding the medical cost of coiling and clipping in patients with unruptured intracranial aneurysms are available [ 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Bih

et al. 2021

IJERPH

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Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence. Results: The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; p < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; p < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; p < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; p < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; p < 0.0001). Conclusions: Medical resource consumption in the coiling group was lower than that in the clipping group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Bih

et al. 2021

IJERPH

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“…Elderly patients treated with clipping had greater odds of perioperative acute renal failure, whereas their coiling counterparts had greater odds of perioperative deep venous thrombosis and pulmonary embolism. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Analysis of the surgical outcome of unruptured intracranial saccular aneurysms in octogenarians (80–89 Years)

et al. 2020

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Background: The prevalence of unruptured intracranial aneurysms is increasing in elderly population in Japan. Octogenarians (80–89 years) are more prone to complications due to increased age, comorbidities, increased risk of vasospasm, and treatment risks. Aim: The aim is to study the surgical outcome of unruptured intracranial saccular aneurysms in elderly patients aged between 80 and 89 years. Patients and Methods: A retrospective study was conducted involving all the cases of unruptured intracranial saccular aneurysms operated surgically in elderly patients aged between 80 and 89 years. All the cases operated between January 2017 and October 2019 were included in the study. The preoperative neurological status was assessed using the Glasgow Coma Scale (GCS). The comorbidities and risk factors involved were assessed. Postoperative neurological status was assessed by (1) postoperative GCS score and by the (2) presence or absence of the motor weakness of limbs. Results: Thirty-three aneurysms were operated in 27 patients. Two patients were operated two times at separate occasions for different aneurysms during the study period and hence making a total of 29 surgeries. The age range was 80–88 years, with a mean of 82.4 years ± 2.64 standard deviation (SD). There were 7 (24.1%) males and 22 (75.86%) females. All the patients had a preoperative GCS score of 15/15 without focal neurological deficit. The mean size (mm) of the aneurysms was 6.57 ± 4.04 SD. There were 31 (93.94%) aneurysms in the anterior circulation and 2 (6.06%) aneurysms in the posterior circulation. The comorbidities and risk factors were analyzed and found to be not influencing the outcome of the patients. Clipping was done in 32 aneurysms. One case of posterior inferior cerebellar artery (PICA) aneurysm underwent occipital artery to PICA bypass surgery. The postoperative complications include chronic subdural hematoma (CSDH) in 7 (24.13%) patients, extradural hematoma in 1 (3.4%), meningitis in 1 (3.4%), and lower cranial nerve palsy in 1 (3.4%) patient. All the patients were discharged with GCS score 15/15 without motor weakness of the limbs. The mean duration of stay was 16.62 days ± 9.98 SD. Conclusion: Surgery for unruptured saccular aneurysms in octogenarians has got a good result in the tertiary care facility. Advanced age alone should not be considered for preferring coiling over clipping. Octogenarians are more prone to developing postoperative CSDH.

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“…Unruptured intracranial aneurysms carry a risk of rupture which can lead to intracranial stroke, subarachnoid hemorrhage, coma, or death. [3] Elder age is considered as one of the poor prognosis factors for the management of intracranial aneurysms. [3] Management of unruptured intracranial aneurysms in the elderly remains controversial and challenging in cerebrovascular disease because of greater rigidity and turtosity of the arteries, concomitant disease and life expectancy.…”

Section: Introductionmentioning

confidence: 99%

“…[3] Elder age is considered as one of the poor prognosis factors for the management of intracranial aneurysms. [3] Management of unruptured intracranial aneurysms in the elderly remains controversial and challenging in cerebrovascular disease because of greater rigidity and turtosity of the arteries, concomitant disease and life expectancy. [4] Management strategies include surgery, endovascular of conservative management with periodic imaging.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of unruptured cerebral aneurysms in the elderly: An institution experience

et al. 2019

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Background and Purpose: The elderly population is increasing in the world, especially in developed countries. The gain in life expectancy is remarkable in Japan, consequently incidence of aneurysms increases in this population. The purpose of this study is to evaluate the surgical treatment and outcome of patients aged more than 75 years treated for unruptured intracranial aneurysms. Patients and Methods: We conducted a retrospective study for unruptured cerebral aneurysms operated between September 2014 and August 31, 2018, in Fujita Health University, Banbuntane Hotokukai Hospital, for people aged more than 75 years. A demographic study was done. We also studied aneurysm location, aneurysm size, outcome, duration of stay, and complications. Results: About 61 patients aged more than 75 years were operated in 4 years, comprising 12 males and 45 females. The mean age was 79.32 ± 3.29 years. Mean size of the aneurysm was 6.22 ± 3.28. Aneurysm location ( P = 0.0037), associated risk factors ( P = 0.006), and association of hypertension and diabetes ( P = 0.0362) influence outcome. Length of stay is directly correlated with outcome ( P = 0.009). Conclusions: Elder patients with hypertension and diabetes or associated risk factors having a posterior circulation aneurysm have a poor diagnosis.

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Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping

Cited by 34 publications

References 33 publications

Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Analysis of the surgical outcome of unruptured intracranial saccular aneurysms in octogenarians (80–89 Years)

Surgical management of unruptured cerebral aneurysms in the elderly: An institution experience

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