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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Cost analysis and outcomes of Woven EndoBridge Device embolization vs microsurgical clipping for intracranial
Joanna M Roy1, Basel Musmar1, Vinay Pedapati1
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Objective:
Woven EndoBridge Device (WEB) embolization is an endovascular technique used to intracranial bifurcation aneurysms. Although WEB embolization is a less invasive alternative to microsurgical clipping, it may be associated with higher rates of recurrence and retreatment. Our study compares hospitalization costs and outcomes with WEB embolization versus microsurgical clipping.
Methods:
This was a single-center retrospective study of patients who underwent WEB embolization or microsurgical clipping of intracranial bifurcation aneurysms. The primary outcome of interest was total hospitalization cost. Secondary outcomes were post-operative complications, length of stay (LOS), functional outcome, non-home discharge (NHD), mortality, aneurysm recurrence and retreatment.
Results:
Of 188 patients, 61 were treated using WEB embolization and 127 underwent microsurgical clipping. Median (IQR) total hospitalization costs were higher for WEB embolization ($41918, 35309-72641) compared to microsurgical clipping ($34050, 27068-48998) (P < 0.001)). On linear regression, ruptured aneurysms ($14437.84, 95 % CI: 7406.93 - 21468.76, P < 0.001) and per-day increase in LOS ($5826.66, 5381.43 - 6271.90, P < 0.001) were independently associated with increased total hospitalization costs, while microsurgical clipping was associated with a $22756 decrease in total hospitalization costs (95 % CI: -26885.36 - -18628.10, P < 0.001). Median LOS was significantly higher in the microsurgical clipping cohort (3 (3-6) compared to the WEB cohort (1 (1-5.5)) (P < 0.001). The WEB cohort had a higher proportion of patients with incomplete occlusion (34.6 % vs 12.5 % (P < 0.001)). Complications, functional outcome, NHD, mortality and retreatment rates were comparable.
Conclusions:
Our results show that WEB embolization for bifurcation aneurysms resulted in higher hospital costs, shorter LOS and increased recurrence rates compared to microsurgical clipping. Long-term studies are needed to clarify the economic impact of these treatment modalities.
