Length of Stay and Total Hospital Charges of Clipping Versus Coiling for Ruptured and Unruptured Adult Cerebral Aneurysms in the Nationwide Inpatient Sample Database 2002 to 2006

Abstract

Background and Purpose-We have previously reported the difference in length of stay and hospital charges for patients with cerebral aneurysms treated with either clipping or coiling at our institution. We now report an analysis of the same comparison at a national level conducted using the Nationwide Inpatient Sample database. hospitalizations for unruptured aneurysm treatments (4700 clipping, 4699 coiling). For ruptured aneurysm patients, after adjusting for the effects of patient-specific and hospital-specific factors, clipping compared to coiling was associated with significantly longer length of stay (PϽ0.0001) and significantly higher total hospital charges (PϽ0.0001). For unruptured aneurysm patients, clipping compared to coiling was associated with significantly longer length of stay (PϽ0.0001) and significantly higher total hospital charges (PϽ0.0001). After adjusting for the effects of hospital-level and patient-level characteristics, clipping as compared to coiling was associated with an average of 1.2-times more days in hospitalization for ruptured patients and was associated with an average of 1.8-times more days in hospitalization for unruptured patients. On average, clipping resulted in $15 325 more in total charge for ruptured patients and resulted in $11 263 more in total charge for unruptured patients after considering all relevant hospital and patient characteristics. Conclusions-The results of this nationwide analysis differed from the findings of our single institution study. Clipping compared to coiling was associated with significantly longer lengths of stay and significantly higher total hospital charges for both ruptured and unruptured aneurysm patients. (Stroke. 2010;41:337-342.)

Estrogen Deficiency Promotes Cerebral Aneurysm Rupture by Upregulation of Th17 Cells and Interleukin‐17A Which Downregulates E‐Cadherin

“…These previous studies do not corroborate what we observe clinically. In humans, aneurysms occur more often in women (70–75%) pre‐ and postmenopause 2. However, aneurysm ruptures occur most often in postmenopausal women 3, 4…”

“…Estrogen deficiency has been linked to aneurysm formation and rupture. Approximately 70% to 75% of aneurysms occur in women,2 with postmenopausal women having the highest risk for aneurysm rupture 3, 4. Several studies have investigated estrogen deficiency and CA5, 6, 7, 8; however, the mechanism remains unknown.…”

Treatment of Multiple Intracranial Aneurysms with 1-Stage Coiling

“…Coiling was associated with significantly shorter lengths of hospital stay and significantly lower total hospital charges for patients with both ruptured and unruptured aneurysms, compared with clipping. 19 One-stage coiling of multiple aneurysms may further shorten the lengths of overall hospital stays and reduce overall total medical costs.…”

Hospitalization Costs for Endovascular and Surgical Treatment of Unruptured Cerebral Aneurysms in the United States Are Substantially Higher Than Medicare Payments

“…Hoh et al 4 reported the cost of cerebral aneurysm treatment in a previous study using NIS data, showing that clipping was associated with significantly longer stay and significantly higher total hospital charges than coiling for patients with both ruptured and unruptured aneurysms. We sought to delineate further the reasons for cost differentials in unruptured aneurysms by stratifying patients by age and outcome and by evaluating the trend in cost with time.…”