Clipping aneurysms improves outcomes for patients undergoing coiling

Area of Science:

• Neurosurgery
• Vascular Neurology
• Health Services Research

Background:

• Endovascular treatment is preferred for intracranial aneurysms, offering superior outcomes for aneurysmal subarachnoid hemorrhage (aSAH).
• Microsurgery remains necessary for select aSAH cases.
• The impact of surgical volume on aSAH patient outcomes requires further investigation.

Purpose of the Study:

• To examine the relationship between microsurgical case volume and patient outcomes for aSAH.
• To determine if microsurgical activity influences outcomes in neurosurgical centers in England.

Main Methods:

• Utilized the Neurosurgical National Audit Programme (NNAP) database for aSAH cases and 30-day mortality rates across 24 English neurosurgical centers.
• Employed regression analysis (Pearson correlation) and ANOVA for statistical significance testing.
• Validated NNAP data with the British Neurovascular Group's (BNVG) National Subarachnoid Haemorrhage Database.

Main Results:

• Increased microsurgical case numbers correlated with lower 30-day mortality rates for all aSAH patients (Pearson r = 0.42, p = 0.04).
• This association persisted even for patients treated with endovascular procedures (Pearson r = 0.42, p = 0.04).
• Correlations were stronger when including all microsurgical cases (elective and acute).

Conclusions:

• A significant association exists between local microsurgical activity and improved center outcomes for aSAH patients.
• Higher microsurgical volumes may indicate greater neurosurgical expertise and optimal case selection in neurovascular care.
• These findings highlight the importance of neurosurgical involvement in managing aSAH patients, irrespective of treatment modality.