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Abstract Details

Endovascular Therapy Versus Clipping For Aneurysmal Subarachnoid Hemorrhage, 2004-2014 Trends
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (5:30 PM-6:30 PM)
3-026

We investigated the effects of increasing adoption of endovascular therapy for aneurysmal subarachnoid hemorrhage using the Nationwide Inpatient Sample (NIS) database.

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Using the 2004-2014 NIS, aSAH patients aged >18 were identified and data was extracted. Endovascular therapy was identified using ICD-9 codes 39.72, 39.75, 39.76 and 39.79. Clipping was identified using ICD-9 code 39.51. Poor outcome was defined as in-hospital mortality, discharge to institutional care or placement of tracheostomy and/or gastrostomy. Unweighted discharge records were used.

Over the ten years we studied, we found 52864 patients. In 2004, clipping was used in 25% of patients(n=1290), endovascular therapy in 15%(n=771); by 2014, clipping had fallen to 13%(n=630), while 29% underwent endovascular therapy(n=1374). In the group as a whole, in-hospital mortality declined from 26% in 2004 to 19% in 2014 (p<0.0001), and poor outcome declined from 63% in 2004 to 58% in 2014 (p<0.0001).

 

The average age, sex ratio and proportion of White ethnicity was the same in the endovascular and clipping groups. The average length of stay did not significantly change over the years in either group. Average total charges showed a rise over the years (p<0.001). Charges (inflation-adjusted, 2014 dollars) were similar in the beginning (endovascular $196355 vs clipping $191855 in 2004), showed some divergence by 2014 (endovascular $368,326 vs clipping $394,036), but there was no significant difference between the groups. No significant mortality difference was seen between the endovascular and clipping populations (2004: 16% vs 10%, p=0.058; 2014: 10.7% vs 10.1%, p=0.707).

Between 2004 and 2014, endovascular therapy has become more popular for aneurysmal SAH than clipping. There has been a decline in mortality overall. There was no significant difference in length of stay, mortality or hospital charges between patients treated with endovascular therapy and clipping.

Authors/Disclosures
Anand Venkatraman, MBBS (Ocala Regional Medical Center)
PRESENTER
No disclosure on file
Ayaz M. Khawaja, MD Dr. Khawaja has nothing to disclose.
No disclosure on file
No disclosure on file