Jian-Han Chen1, Chih-Yuan Huang2, Yi-Che Lee3, Kuo-Wei Wang4, Po-Chou Liliang4, Cheng-Loong Liang5, Kang Lu5, Han-Jung Chen5, Yuan-Ting Sun6, Hao-Kuang Wang7. 1. Department of General Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. 2. Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan. 3. Department of Nephrology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan. 4. Department of Neurosurgery, Cancer E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan. 5. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. 6. Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 7. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Electronic address: ed101393@gmail.com.
Abstract
OBJECTIVE: Using a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling. METHODS: This study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined. RESULTS: A total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P < 0.001) and significantly higher total hospital costs (P < 0.001). CONCLUSIONS: In Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.
OBJECTIVE: Using a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling. METHODS: This study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined. RESULTS: A total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P < 0.001) and significantly higher total hospital costs (P < 0.001). CONCLUSIONS: In Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.
Authors: Jose A Figueroa-Sanchez; Ana S Ferrigno; David E Hinojosa-González; Gustavo Salgado-Garza; Hector R Martinez; Enrique Caro-Osorio; Jesus G Garza-Garcia Journal: Interv Neuroradiol Date: 2020-04-21 Impact factor: 1.610