Cerebrovascular disease is a leading cause of serious long-term disability, affecting as many as 700,000 people every year.
Subarachnoid hemorrhage (SAH) affects approximately 30,000 Americans every year, with 90 percent of all cases caused by cerebral aneurysms. Up to 6 percent of the U.S. population may be living with unruptured aneurysms. Aneurysms occur in all age groups, but the incidence increases steadily for individuals age 25 and older, is most prevalent in people ages 50 to 60, and about three times more prevalent in women. Of those who suffer ruptured aneurysms, about one half will not survive beyond 30 days, and an additional 25 percent will have some form of neurological deficit.
There are currently three treatment options for people with the diagnosis of a cerebral aneurysm: 1) Nonsurgical therapy; 2) Surgical therapy/clipping; and 3) Endovascular therapy/coiling. The most appropriate treatment of cerebral aneurysms, both ruptured and unruptured, is currently under debate. The debate centers primarily on efficacy and outcome comparisons of clipping versus coiling.
Recently, researchers undertook a study identifying trends in cerebral aneurysm treatment in the United States. To accomplish this task, the database of the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality was reviewed. The NIS is the largest all-payer inpatient care database in the United States. The data includes 100 percent of discharges from a stratified random sample of nonfederal hospitals in 19 to 28 states. Thus, a representative 20 percent sub-sample of the entire United States is included in these hospital discharges, equating to approximately 8 million hospital stays from 1,000 hospitals.
The results of this study, Current Trends in the Treatment of Cerebral Aneurysms: Analysis of a Nationwide Inpatient Database, will be presented by Norberto Andaluz, MD, 3:50 to 4:00 p.m. on Wednesday, April 18, 2007, during the 75th Annual Meeting of the American Association of Neurological Surgeons in Washington, D.C. The co-author is Mario Zuccarello, MD.
In this study, researchers retrospectively reviewed data from the NIS database for the period 1993-2003; this period represents the earliest and latest available years of data at the time of the study. Multiple variables were subjected to logistic regression analysis for International Classification of Diseases (ICD)-9-CM codes related to SAH, unruptured aneurysm, and clipping and endovascular treatment of cerebral aneurysm. Using this approach, a sample of 506,040 patients was accrued for review. The following trends were noted: