In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 995-1009 ◽  
Author(s):  
Fred G. Barker ◽  
Sepideh Amin-Hanjani ◽  
William E. Butler ◽  
Christopher S. Ogilvy ◽  
Bob S. Carter
Keyword(s):  
United States ◽  
Surgical Treatment ◽  
Hospital Mortality ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Surgeon Volume ◽  
Mortality And Morbidity ◽  
Unruptured Intracranial Aneurysms

In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 995-1009
Author(s):  
Fred G. Barker ◽  
Sepideh Amin-Hanjani ◽  
William E. Butler ◽  
Christopher S. Ogilvy ◽  
Bob S. Carter
Keyword(s):  
United States ◽  
Surgical Treatment ◽  
Length Of Stay ◽  
Intracranial Aneurysms ◽  
High Volume ◽  
The United States ◽  
Surgeon Volume ◽  
Hospital Charges ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms

Abstract OBJECTIVE We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care. METHODS We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms. CONCLUSION For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.

scholarly journals Better Outcomes with Treatment by Coiling Relative to Clipping of Unruptured Intracranial Aneurysms in the United States, 2001–2008

2011 ◽  
Vol 32 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
W. Brinjikji ◽  
A.A. Rabinstein ◽  
D.M. Nasr ◽  
G. Lanzino ◽  
D.F. Kallmes ◽  
...  
Keyword(s):  
United States ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Unruptured Intracranial Aneurysms

scholarly journals Impact of unruptured intracranial aneurysms on public health in the United States.

Stroke ◽  
1992 ◽  
Vol 23 (10) ◽  
pp. 1416-1419 ◽  
Author(s):  
D O Wiebers ◽  
J C Torner ◽  
I Meissner
Keyword(s):  
Public Health ◽  
United States ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Unruptured Intracranial Aneurysms

scholarly journals Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: Hospital and surgeon volume-related outcomes

2003 ◽  
Vol 37 (6) ◽  
pp. 1169-1174 ◽  
Author(s):  
John A Cowan ◽  
Justin B Dimick ◽  
Peter K Henke ◽  
Thomas S Huber ◽  
James C Stanley ◽  
...  
Keyword(s):  
United States ◽  
Surgical Treatment ◽  
The United States ◽  
Surgeon Volume ◽  
Aortic Aneurysms

scholarly journals Cost-Effectiveness of Computed Tomography Angiography in Management of Tiny Unruptured Intracranial Aneurysms in the United States

Stroke ◽  
2019 ◽  
Vol 50 (9) ◽  
pp. 2396-2403 ◽  
Author(s):  
Xiao Wu ◽  
Charles C. Matouk ◽  
Rajiv Mangla ◽  
Howard P. Forman ◽  
Dheeraj Gandhi ◽  
...  
Keyword(s):  
United States ◽  
Computed Tomography ◽  
Cost Effectiveness ◽  
Computed Tomography Angiography ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Unruptured Intracranial Aneurysms
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