Paradoxical trends in the management of unruptured cerebral aneurysms in the united states: Analysis of nationwide database over a 10-year period

Michael C. Huang, Mhd-Ali - Baaj, Katheryne Downes, A. Samy Youssef, Eric Sauvageau, Harry R. Van Loveren, Siviero Agazzi

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background And Purpose- The objective of this study was to characterize demographics, treatments, and outcomes in the management of unruptured cerebral aneurysms in the United States using a national healthcare database. Methods- Clinical data were derived from the Nationwide Inpatient Sample for the years 1997 through 2006. Patients with unruptured cerebral aneurysms were identified using the appropriate International Classification of Diseases, 9th Revision code (437.3). Hospitalizations, length of stay, hospital charges, discharge pattern, age and gender distribution, and nature of intervention were analyzed. A Bureau of Labor statistics tool was used to adjust hospital and national charges for inflation. Population-adjusted rates were calculated using population estimates generated by the US Census Bureau. Results- Over 100 000 records were retrieved for analysis. During the time period studied, there was a 75% increase in the number of hospitalizations associated with unruptured cerebral aneurysms. Inflation adjusted hospital charges increased by 60%, whereas the total national bill increased by 200%. Overall, length of stay decreased by 37% and in-hospital mortality rates decreased by 54%. The increasing number of hospitalizations and total national charges related to inpatient treatment of unruptured aneurysms were significantly associated with endovascular treatment rather than surgical clipping. Conclusions- Despite recent studies suggesting a low risk of rupture of incidentally diagnosed cerebral aneurysms, data from this study suggest an increasing trend of treatment for this entity in the United States. Furthermore, endovascular intervention is now the major driving force behind the increasing overall national charges. Given the current healthcare climate, the impact of these trends warrants discussion and debate.

Original languageEnglish (US)
Pages (from-to)1730-1735
Number of pages6
JournalStroke
Volume42
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Hospital Charges
Databases
Hospitalization
Economic Inflation
Inpatients
Length of Stay
Delivery of Health Care
Age Distribution
International Classification of Diseases
Censuses
Hospital Mortality
Climate
Population
Aneurysm
Rupture
Therapeutics
Demography
Mortality

Keywords

  • aneurysms
  • endovascular
  • healthcare
  • Nationwide Inpatient Sample

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Paradoxical trends in the management of unruptured cerebral aneurysms in the united states : Analysis of nationwide database over a 10-year period. / Huang, Michael C.; Baaj, Mhd-Ali -; Downes, Katheryne; Youssef, A. Samy; Sauvageau, Eric; Van Loveren, Harry R.; Agazzi, Siviero.

In: Stroke, Vol. 42, No. 6, 06.2011, p. 1730-1735.

Research output: Contribution to journalArticle

Huang, Michael C. ; Baaj, Mhd-Ali - ; Downes, Katheryne ; Youssef, A. Samy ; Sauvageau, Eric ; Van Loveren, Harry R. ; Agazzi, Siviero. / Paradoxical trends in the management of unruptured cerebral aneurysms in the united states : Analysis of nationwide database over a 10-year period. In: Stroke. 2011 ; Vol. 42, No. 6. pp. 1730-1735.
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abstract = "Background And Purpose- The objective of this study was to characterize demographics, treatments, and outcomes in the management of unruptured cerebral aneurysms in the United States using a national healthcare database. Methods- Clinical data were derived from the Nationwide Inpatient Sample for the years 1997 through 2006. Patients with unruptured cerebral aneurysms were identified using the appropriate International Classification of Diseases, 9th Revision code (437.3). Hospitalizations, length of stay, hospital charges, discharge pattern, age and gender distribution, and nature of intervention were analyzed. A Bureau of Labor statistics tool was used to adjust hospital and national charges for inflation. Population-adjusted rates were calculated using population estimates generated by the US Census Bureau. Results- Over 100 000 records were retrieved for analysis. During the time period studied, there was a 75{\%} increase in the number of hospitalizations associated with unruptured cerebral aneurysms. Inflation adjusted hospital charges increased by 60{\%}, whereas the total national bill increased by 200{\%}. Overall, length of stay decreased by 37{\%} and in-hospital mortality rates decreased by 54{\%}. The increasing number of hospitalizations and total national charges related to inpatient treatment of unruptured aneurysms were significantly associated with endovascular treatment rather than surgical clipping. Conclusions- Despite recent studies suggesting a low risk of rupture of incidentally diagnosed cerebral aneurysms, data from this study suggest an increasing trend of treatment for this entity in the United States. Furthermore, endovascular intervention is now the major driving force behind the increasing overall national charges. Given the current healthcare climate, the impact of these trends warrants discussion and debate.",
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