scholarly journals A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms

2016 ◽  
Vol 125 (3) ◽  
pp. 713-719 ◽  
Author(s):  
William C. Newman ◽  
Dan W. Neal ◽  
Brian L. Hoh
Keyword(s):  
Length Of Stay ◽  
Risk Stratification ◽  
Risk Score ◽  
Cerebral Aneurysms ◽  
Hospital Charges ◽  
Poor Outcome ◽  
Comorbidity Index ◽  
Unruptured Cerebral Aneurysms ◽  
The Impact ◽  
Outcome Mortality

OBJECTIVE Comorbidities have an impact on risk stratification for outcomes in analyses of large patient databases. Although the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) are the most commonly used comorbidity indexes, these have not been validated for patients with unruptured cerebral aneurysms; therefore, the authors created a comorbidity index specific to these patients. METHODS The authors extracted all records involving unruptured cerebral aneurysms treated with clipping, coiling, or both from the Nationwide Inpatient Sample (2002–2010). They assessed the effect of 37 variables on poor outcome and used the results to create a risk score for these patients. The authors used a validation data set and bootstrapping to evaluate the new index and compared it to CCI and ECI in prediction of poor outcome, mortality, length of stay, and hospital charges. RESULTS The index assigns integer values (−2 to 7) to 20 comorbidities: neurological disorder, renal insufficiency, gastrointestinal bleeding, paralysis, acute myocardial infarction, electrolyte disorder, weight loss, metastatic cancer, drug abuse, arrhythmia, coagulopathy, cerebrovascular accident, psychosis, alcoholism, perivascular disease, valvular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia. Values are summed to determine a patient's risk score. The new index was better at predicting poor outcome than CCI or ECI (area under the receiver operating characteristic curve [AUC] 0.814 [95% CI 0.798–0.830], vs 0.694 and 0.712, respectively, for the other indices), and it was also better at predicting mortality (AUC 0.775 [95% CI 0.754–0.792], vs 0.635 and 0.657, respectively, for CCI and ECI). CONCLUSIONS This new comorbidity index outperforms the CCI and ECI in predicting poor outcome, mortality, length of stay, and total charges for patients with unruptured cerebral aneurysm. Reevaluation of other patient cohorts is warranted to determine the impact of more accurate patient stratification.

scholarly journals Small vs. Large Unruptured Cerebral Aneurysm: Concerns With the Age of Patient

2021 ◽  
Vol 12 ◽  
Author(s):  
Jianfeng Zheng ◽  
Ru Xu ◽  
Xiaochuan Sun ◽  
Xiaodong Zhang
Keyword(s):  
Older Patients ◽  
Multivariable Analysis ◽  
Cerebral Aneurysms ◽  
Preventive Treatment ◽  
Maximum Diameter ◽  
Poor Outcome ◽  
Clinical Complications ◽  
Unruptured Cerebral Aneurysm ◽  
Unruptured Cerebral Aneurysms ◽  
The Impact

Objective: The coiling and clipping of unruptured cerebral aneurysms (UCAs) in older patients has increased rapidly, and aneurysm size was a significant factor for decision-making in the treatment of UCAs. The purpose of the study was to investigate the impact of age on the functional outcomes of patients between the small versus large UCAs.Methods: We conducted a retrospective study for consecutive cases of UCAs admitted from May 2011 to December 2020. According to the maximum diameter of UCA, patients were divided into small UCAs (≤ 5 mm) group and large UCAs (>5 mm) group. Baseline characteristics, clinical complications, and outcomes of patients between the two groups were analyzed.Results: A total of 564 UCA patients received preventive treatment, including 165 small UCAs and 399 large UCAs. Compared with the small UCA group, the incidence of ischemia event in the large UCA group was significantly higher (7.3 vs. 2.4%; p = 0.029). Multivariable analysis demonstrating age (p = 0.006) and treatment modality (p < 0.001) were independent risk factors associated with poor outcome for patients with large UCAs.Conclusions: Preventive treatment of small UCAs is safe and effective, but older patients with large UCAs are at high risk of poor outcome, and the operations should be more cautious.

scholarly journals 1030. Analysis of a Novel Mortality Prediction Rule for Organizing and Guiding Antimicrobial Stewardship Team Activities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S363
Author(s):  
Curtis D Collins ◽  
Caleb Scheidel ◽  
Christopher J Dietzel ◽  
Lauren R Leeman ◽  
Cheryl A Morrin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Risk Score ◽  
Antimicrobial Stewardship ◽  
Prediction Rule ◽  
Mortality Prediction ◽  
Audit And Feedback ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship team (AST) surveillance at our hospital is facilitated by an internally-developed database. In 2013, the database was expanded to incorporate a validated internally-developed prediction rule for patient mortality within 30 days of hospital admission. AST prospective audit and feedback expanded to include all antimicrobials prescribed in patients with the highest risk for mortality determined by risk score. This study describes the impact of an expanded AST review in patients at the highest risk for mortality. Methods This retrospective, observational study analyzed all adult patients with the highest mortality risk score who received antimicrobials not historically captured via AST review. Patients were identified through administrative and AST databases. Study periods were defined as 2011 – Q3 2013 (historical group) and Q4 2013 – 2018 (intervention group). Primary and secondary outcomes were assessed for confounders including demographic data and infection-related diagnoses. Outcomes were assessed using both unweighted and propensity score weighted versions of the t-test or Wilcoxon rank-sum test for continuous variables and the chi-squared test or Fisher’s Exact test for discrete variables. Results A total of 2,852 and 5,460 patients were included in the historical and intervention groups, respectively. After adjusting for demographic and clinical characteristics, there were significant reductions in median antimicrobial duration (5 vs. 4, P = 0.002), antimicrobial days of therapy (7 vs. 7, P = 0.001), length of stay (LOS) (6 vs. 5 days, P = 0.001), intensive care unit (ICU) LOS (3 vs. 2 days, P < 0.001), and total hospital cost ($11,017 vs. $9,134, P < 0.001) in the intervention cohort. There were no significant differences observed in 30-day mortality or 30-day readmissions. Secondary analyses showed significant decreases in fluroquinolone and intravenous vancomycin utilization between cohorts. Conclusion Reductions in antimicrobial use, inpatient and ICU length of stay, and total hospital costs were observed in a cohort of patients following incorporation of a novel mortality prediction rule to guide AST surveillance. Disclosures All authors: No reported disclosures.

Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System

2020 ◽  
Vol 10 (10) ◽  
pp. 836-843
Author(s):  
Megan Farrell ◽  
Sarah Bram ◽  
Hongjie Gu ◽  
Shakila Mathew ◽  
Elizabeth Messer ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Peripheral Blood ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Significant Difference ◽  
Contaminated Blood ◽  
The Impact ◽  
Care System

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P &lt; .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P &lt; .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.

scholarly journals The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms

2017 ◽  
Vol 126 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
Nicos Labropoulos ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Unruptured Cerebral Aneurysm ◽  
Hospital Referral ◽  
Unruptured Cerebral Aneurysms ◽  
The Impact ◽  
Aneurysm Coiling

OBJECTIVE The impact of combined practices on the outcomes of unruptured cerebral aneurysm coiling remains an issue of debate. The authors investigated the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm coiling. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent endovascular coiling for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding, the authors used propensity score conditioning, with mixed effects to account for clustering at the hospital referral region level. RESULTS During the study period, there were 11,716 patients who underwent endovascular coiling for unruptured cerebral aneurysms and met the inclusion criteria. Of these, 1186 (10.1%) underwent treatment performed by hybrid neurosurgeons, and 10,530 (89.9%) by proceduralists who performed only endovascular coiling. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR 0.84; 95% CI 0.58–1.23), discharge to rehabilitation (OR 1.0; 95% CI 0.66–1.51), 30-day readmission rate (OR 1.07; 95% CI 0.83–1.38), and length of stay (adjusted difference, 0.41; 95% CI −0.26 to 1.09). Higher procedural volume was independently associated with improved outcomes. CONCLUSIONS In a cohort of Medicare patients, the authors did not demonstrate a difference in mortality, discharge to rehabilitation, readmission rate, and LOS between hybrid neurosurgeons and proceduralists performing only endovascular coiling.

scholarly journals Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1693
Author(s):  
Daryl Ramai ◽  
Khoi P. Dang-Ho ◽  
Anjali Kewalramani ◽  
Praneeth Bandaru ◽  
Rodolfo Sacco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Encephalopathy ◽  
Length Of Stay ◽  
Risk Score ◽  
Cox Regression ◽  
Surrogate Marker ◽  
Hospital Length Of Stay ◽  
Frail Patients ◽  
Increased Risk ◽  
The Impact

Frailty represents a state of vulnerability to multiple internal physiologic factors, as well as external pressures, and has been associated with clinical outcomes. We aim to understand the impact of frailty on patients admitted with hepatocellular carcinoma (HCC) by using the validated Hospital Frailty Risk Score, which is implemented in several hospitals worldwide. We conducted a nation-wide retrospective cohort study to determine the effect of frailty on the risk of in-patient mortality, hepatic encephalopathy, length of stay and cost. Frailty was associated with a 4.5-fold increased risk of mortality and a 2.3-fold increased risk of hepatic encephalopathy. Adjusted Cox regression showed that frailty was correlated with increased risk of in-patient mortality (hazard ratio: 2.3, 95% CI 1.9–2.8, p < 0.001). Frail HCC patients had longer hospital stay (median 5 days) vs. non-frail HCC patients (median 3 days). Additionally, frail patients had higher total costs of hospitalization ($40,875) compared with non-frail patients ($31,667). Frailty is an independent predictor of hepatic encephalopathy and in-patient mortality. Frailty is a surrogate marker of hospital length of stay and cost.

The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges

2005 ◽  
Vol 26 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Youlin Qi ◽  
Keith S. Kaye ◽  
Stephan Harbarth ◽  
Adolf W. Karchmer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Hospital Charge ◽  
Hospital Charges ◽  
The Impact ◽  
Length Of Hospitalization

AbstractObjective:To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.Design:A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.Setting:A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.Patients:Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.Results:Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.Conclusion:Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.

scholarly journals Broadly Applicable Risk Stratification System for Predicting Duration of Hospitalization and Mortality

2010 ◽  
Vol 113 (5) ◽  
pp. 1026-1037 ◽  
Author(s):  
Daniel I. Sessler ◽  
Jeffrey C. Sigl ◽  
Paul J. Manberg ◽  
Scott D. Kelley ◽  
Armin Schubert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Risk Adjustment ◽  
Charlson Comorbidity Index ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Administrative Claims ◽  
Median Length ◽  
Comorbidity Index

Background Hospitals are increasingly required to publicly report outcomes, yet performance is best interpreted in the context of population and procedural risk. We sought to develop a risk-adjustment method using administrative claims data to assess both national-level and hospital-specific performance. Methods A total of 35,179,507 patient stay records from 2001-2006 Medicare Provider Analysis and Review (MEDPAR) files were randomly divided into development and validation sets. Risk stratification indices (RSIs) for length of stay and mortality endpoints were derived from aggregate risk associated with individual diagnostic and procedure codes. Performance of RSIs were tested prospectively on the validation database, as well as a single institution registry of 103,324 adult surgical patients, and compared with the Charlson comorbidity index, which was designed to predict 1-yr mortality. The primary outcome was the C statistic indicating the discriminatory power of alternative risk-adjustment methods for prediction of outcome measures. Results A single risk-stratification model predicted 30-day and 1-yr postdischarge mortality; separate risk-stratification models predicted length of stay and in-hospital mortality. The RSIs performed well on the national dataset (C statistics for median length of stay and 30-day mortality were 0.86 and 0.84). They performed significantly better than the Charlson comorbidity index on the Cleveland Clinic registry for all outcomes. The C statistics for the RSIs and Charlson comorbidity index were 0.89 versus 0.60 for median length of stay, 0.98 versus 0.65 for in-hospital mortality, 0.85 versus 0.76 for 30-day mortality, and 0.83 versus 0.77 for 1-yr mortality. Addition of demographic information only slightly improved performance of the RSI. Conclusion RSI is a broadly applicable and robust system for assessing hospital length of stay and mortality for groups of surgical patients based solely on administrative data.

Validation of a neurovascular comorbidities index for retrospective database analysis

2018 ◽  
Vol 130 (1) ◽  
pp. 273-277
Author(s):  
William C. Newman ◽  
Paul S. Kubilis ◽  
Brian L. Hoh
Keyword(s):  
Carotid Artery ◽  
Intracranial Aneurysm ◽  
Risk Stratification ◽  
Patient Outcomes ◽  
Dural Arteriovenous Fistula ◽  
Surgical Intervention ◽  
Total Cost ◽  
Poor Outcome ◽  
Ruptured Intracranial Aneurysm ◽  
Comorbidity Index

OBJECTIVEComorbidities have a significant effect on patient outcomes. Accounting for this effect is especially important in retrospective reviews of large databases; overpowered studies are at risk for finding significant results because of inaccurate patient risk stratification. The authors previously created a neurovascular comorbidities index (NCI) for patients with an unruptured intracranial aneurysm and found that the model’s ability to predict patient outcomes was statistically significantly improved over that of the routinely used Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). In this study, the authors aimed to validate use of the NCI over that of the CCI and ECI for risk stratification of patients with other neurovascular diseases.METHODSThe authors queried the National (Nationwide) Inpatient Sample database for the years 2002–2012 to compare the accuracy of the previously validated NCI with that of the CCI and ECI with respect to predicting outcomes for patients who had an arteriovenous malformation, a ruptured intracranial aneurysm, carotid artery stenosis, or dural arteriovenous fistula and who underwent surgical intervention.RESULTSFor patients with an arteriovenous malformation, the NCI outperformed the CCI and ECI in predicting poor outcome, hospital length of stay (LOS), and total cost but was equivalent to the CCI in predicting death. For patients with a ruptured intracranial aneurysm, the NCI outperformed the ECI and CCI in predicting death, poor outcome, LOS, and total cost. For patients with carotid artery stenosis, the NCI outperformed the ECI and CCI in predicting LOS, but it was equivalent to the ECI in predicting death and total cost and inferior to the CCI in predicting poor outcome (p < 0.002 for all). An insufficient number of patients with dural arteriovenous fistula who underwent surgical intervention were available for analysis (n < 10), and they therefore were excluded from study. For 11 of 12 metrics, the NCI was the significantly more efficient model.CONCLUSIONSThe NCI outperforms the CCI and ECI by providing more appropriate and efficient risk stratification of patients regarding death, outcome, LOS, and cost. Given this finding, the NCI should be used for retrospective reviews of patient outcomes instead of the CCI or ECI.

To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

2018 ◽  
Vol 32 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Albert H. Zhou ◽  
Sei Y. Chung ◽  
Michael J. Sylvester ◽  
Michael Zaki ◽  
Peter S. Svider ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
The Elderly ◽  
Primary Diagnosis ◽  
Pulmonary Complications ◽  
Nasal Packing ◽  
Hospital Charges ◽  
Cardiac Complications ◽  
The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

THE EFFECT OF COILING VERSUS CLIPPING OF RUPTURED AND UNRUPTURED CEREBRAL ANEURYSMS ON LENGTH OF STAY, HOSPITAL COST, HOSPITAL REIMBURSEMENT, AND SURGEON REIMBURSEMENT AT THE UNIVERSITY OF FLORIDA

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 614-621 ◽  
Author(s):  
Brian L. Hoh ◽  
Yueh-Yun Chi ◽  
Margaret A. Dermott ◽  
Paul J. Lipori ◽  
Stephen B. Lewis
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Costs ◽  
Cerebral Aneurysms ◽  
Hospital Charges ◽  
University Of Florida ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
The University ◽  
Length Of Hospitalization

Abstract OBJECTIVE There are few studies comparing the economic costs and reimbursements for aneurysm clipping versus coiling, and none are from the United States. Our hypothesis predicted that coiling would result in shorter lengths of hospitalization than clipping in patients with unruptured aneurysms and would therefore result in lower hospital charges. However, because of the severity of subarachnoid hemorrhage, there would be no difference in length of hospitalization or hospital charges in patients with ruptured aneurysms. METHODS We compared aneurysm coiling with aneurysm clipping in patients with unruptured and ruptured aneurysms treated at the University of Florida from January 2005 to June 2007 for differences in length of hospitalization, hospital costs, hospital collections, and surgeon collections. Patient demographic and aneurysm characteristic data were obtained from a clinical database. Length of hospitalization, cost, billing, and collection data were obtained from the hospital cost accounting database. Multivariate statistical analyses of length of hospitalization, hospital costs, hospital collections, and surgeon collections were performed using factors including patient age, sex, aneurysm size, aneurysm location, aneurysm treatment, presence of subarachnoid hemorrhage, clinical grade, payor, hospital billing, and surgeon billing. RESULTS There were 565 patients with cerebral aneurysms treated either surgically (306 patients, 54%) or endovascularly (259 patients, 46%). In patients without subarachnoid hemorrhage (unruptured aneurysms) (n = 367), surgery, compared with endovascular treatment, was associated with longer hospitalization (P &lt; 0.001), but lower hospital costs (P &lt; 0.001), higher surgeon collections (P = 0.003), and similar hospital collections. In patients with subarachnoid hemorrhage (ruptured aneurysms) (n = 198), surgery was associated with lower hospital costs (P = 0.011), but similar length of stay, surgeon collections, and hospital collections. Larger aneurysm size was significantly associated with longer hospitalization in the patients with unruptured aneurysms (P &lt; 0.001) and higher hospital costs for both patients with unruptured (P &lt; 0.001) and ruptured (P = 0.015) aneurysms. The payor was significantly associated with hospital costs in patients with ruptured aneurysms (P = 0.034) and length of stay (unruptured aneurysms, P &lt; 0.001; ruptured aneurysms, P &lt; 0.001), hospital collections (unruptured aneurysms, P &lt; 0.001; ruptured aneurysms, P &lt; 0.001), and surgeon collections (unruptured aneurysms, P &lt; 0.001; ruptured aneurysms, P &lt; 0.001) in both patients with unruptured and ruptured aneurysms. A worse clinical grade was significantly associated with higher hospital costs (P &lt; 0.001). CONCLUSION Despite a shorter length of hospitalization in patients with unruptured aneurysms, coiling was associated with higher hospital costs in both patients with unruptured and ruptured aneurysms. This is likely attributable to the higher device cost of coils than clips. The advantages of coiling over clipping would be better realized if the cost of coils could be comparably reduced to that of clips.

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