| アブストラクト | OBJECTIVE Although heterogeneity in patient outcomes following subarachnoid hemorrhage (SAH) has been observed across different centers, the relative merits of clipping and coiling for SAH remain unknown. The authors sought to compare the patient outcomes between these therapeutic modalities using a large nationwide discharge database encompassing hospitals with different comprehensive stroke center (CSC) capabilities. METHODS They analyzed data from 5214 patients with SAH (clipping 3624, coiling 1590) who had been urgently hospitalized at 393 institutions in Japan in the period from April 2012 to March 2013. In-hospital mortality, modified Rankin Scale (mRS) score, cerebral infarction, complications, hospital length of stay, and medical costs were compared between the clipping and coiling groups after adjustment for patient-level and hospital-level characteristics by using mixed-model analysis. RESULTS Patients who had undergone coiling had significantly higher in-hospital mortality (12.4% vs 8.7%, OR 1.3) and a shorter median hospital stay (32.0 vs 37.0 days, p < 0.001) than those who had undergone clipping. The respective proportions of patients discharged with mRS scores of 3-6 (46.4% and 42.9%) and median medical costs (thousands US$, 35.7 and 36.7) were not significantly different between the groups. These results remained robust after further adjustment for CSC capabilities as a hospital-related covariate. CONCLUSIONS Despite the increasing use of coiling, clipping remains the mainstay treatment for SAH. Regardless of CSC capabilities, clipping was associated with reduced in-hospital mortality, similar unfavorable functional outcomes and medical costs, and a longer hospital stay as compared with coiling in 2012 in Japan. Further study is required to determine the influence of unmeasured confounders. |
|---|
| ジャーナル名 | Journal of neurosurgery |
|---|
| 投稿日 | 2017/5/27 |
|---|
| 投稿者 | Kurogi, Ryota; Kada, Akiko; Nishimura, Kunihiro; Kamitani, Satoru; Nishimura, Ataru; Sayama, Tetsuro; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Yoshimura, Shinichi; Okuchi, Kazuo; Suzuki, Akifumi; Nakamura, Fumiaki; Onozuka, Daisuke; Hagihara, Akihito; Iihara, Koji |
|---|
| 組織名 | 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu;University, Fukuoka.;2Department of Clinical Trials and Research, National Hospital Organization;Nagoya Medical Centre, Nagoya.;3Department of Preventive Medicine and Epidemiologic Informatics, National;Cerebral and Cardiovascular Centre, Suita.;4Department of Public Health/Health Policy, Graduate School of Medicine,;University of Tokyo.;5Integrative Stroke Imaging Centre.;6Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular;Centre, Suita.;7Department of Neurosurgery, Iwate Medical University, Morioka.;8Department of Neurosurgery, Chiba Cerebral and Cardiovascular Centre, Chiba.;9Department of Neurosurgery, Kyorin University, Mitaka.;10Department of Emergency and Critical Care Medicine, Showa University Hospital,;Shinagawa.;11Department of Neurosurgery, Osaka Medical College, Takatsuki.;12Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu.;13Department of Preventive Medicine and Community Health, School of Medicine,;University of Occupational and Environmental Health, Kitakyushu.;14Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya.;15Department of Emergency and Critical Care Medicine, Nara Medical University,;Kashihara.;16Department of Surgical Neurology, Research Institute for Brain and Blood;Vessels-Akita; and.;17Department of Health Communication, Graduate School of Medical Sciences, Kyushu;University, Fukuoka, Japan. |
|---|
| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/28548595/ |
|---|
