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Clipping aneurysms improves outcomes for patients undergoing coiling.

Ian A Anderson1, Ahilan Kailaya-Vasan1, Richard J Nelson2,3

  • 11Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.

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|June 9, 2018
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Higher microsurgical case volumes in neurosurgical centers correlate with better outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH), regardless of treatment type. This suggests neurosurgical involvement is key for optimal patient management.

Keywords:
NNAPNeurosurgical National Audit Programmecerebral aneurysmclipcoilsubarachnoid hemorrhagevascular disorders

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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.