Introduction: There is paucity of data in the literature about the use of different treatment paradigms while managing intracranial aneurysms. Available literature discusses at length patients outcome following clipping or coiling. We tried to study the patient’s outcome when these two modalities are used in varied combinations.
Methods: The NIS database was studied for the patients admitted for ruptured and unruptured aneurysm from the year 2005-2009. Patients were grouped in various categories depending on the type of interventions during their single hospital stay. The groups were A: Only-clipping, B: Only-coiling, C: Re-clipping, D: Re-coiling, E: First clipping and later coiling and F: First coiling and later clipping. This dataset was analyzed using binary logistic regression models to assess the relationship of different treatment protocols, age, gender and co-morbidities which may affect the outcome. Discharge disposition ‘routine’ was taken as a measure of good outcome.
Results: A total of 62,839 inpatient admissions for were analyzed from the year 2005-2009. Patients who did not undergo their principal procedure of either clipping or coiling were excluded from analysis. The most common modality of intervention was coiling 53.65%(Table1) followed by clipping(41.4%) .Re-clipping was done in 286(1.49%) patients and primary coiling and secondary clipping in 68(0.35%) patients. A univariate model was followed by binary logistic regression analysis(Table 2). Re-clipping had a significant independent association with poor outcome (p=0.008 and odds ratio of 1.9).Higher Co-morbidity index (p<0.001, OR 2.1) and presence of SAH (p<0.001, OR 8.7) also predicted for poor outcome.
Conclusions: Subarachnoid hemorrhage is a known predictor of poor outcome. Our study has shown that “patient factors”, high co-morbidity and treatment decision, like “re-clipping” is a predictor of poor outcome. A careful thought needs to be given when re-exploration of craniotomy for aneurysmal clipping is contemplated.
Patient Care: Since this study is a United States population based study, the impact of the results may be of significant public health importance .Multimodality treatment of cerebral aneurysm is common.Re-clipping is not a common option and it has an association with poor outcome.This study will help in better selection of treatment modality.
Learning Objectives: By the conclusion of the session participants should be able to understand the impact of multiple treatment modalities on the outcome of cerebral aneurysm patients.