The emergence of endovascular treatment-only centers for treatment of intracranial aneurysms in the United States

Farhan Siddiq, Malik Adil, Daraspreet Kainth, Sean Moen, Adnan I. Qureshi

Research output: Contribution to journalArticle

Abstract

Background Because of the availability of new technology, the spectrum of endovascular treatment for intracranial aneurysms has expanded widely. Some centers have started offering only endovascular treatment to patients with intracranial aneurysms (endovascular treatment-only centers [ETOCs]). Our objective was to identify the proportion and outcome of patients treated at ETOCs in the United States. Methods We determined the proportion of ETOCs in the United States using Nationwide Inpatient Survey data files from 2010. We compared short-term outcomes between ETOCs and endovascular and surgical treatment centers (ESTCs). The outcomes studied were none to minimal disability, moderate to severe disability, in-hospital mortality, postprocedure complications, length of stay, and hospital charges. Results Out of 85 hospitals performing endovascular treatment of unruptured aneurysms, 13 (15%) were categorized as ETOCs. Out of the 10,447 patients with unruptured aneurysms, 1245 (12%) were treated at ETOCs. ETOCs were more likely to be nonteaching hospitals (55% versus 45%, P =.02). The rates of in-hospital mortality (1.2% versus 1.8%) and none to minimal disability (88% versus 84%) were similar in patients treated at ETOCs and ESTC hospitals. The mean hospitalization charges were similar, but length of stay (4 ± 7 days versus 6 ± 10 days, P <.0001) was significantly shorter among patients treated at ETOCs. Only 2.7% patients required secondary neurosurgical procedures at the ETOCs compared with 5.8% in ESTCs (P =.09). Conclusion The recent emergence of ETOCs and provision of treatment with comparable outcomes and shorter length of stay at these hospitals may change the pattern of intracranial aneurysm treatment in the United States.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

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Intracranial Aneurysm
Therapeutics
Length of Stay
Hospital Mortality
Aneurysm
Neurosurgical Procedures
Hospital Charges
Information Storage and Retrieval

Keywords

  • coil embolization
  • Endovascular embolization
  • surgical treatment
  • unruptured intracranial aneurysm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

The emergence of endovascular treatment-only centers for treatment of intracranial aneurysms in the United States. / Siddiq, Farhan; Adil, Malik; Kainth, Daraspreet; Moen, Sean; Qureshi, Adnan I.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 8, 01.11.2013.

Research output: Contribution to journalArticle

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abstract = "Background Because of the availability of new technology, the spectrum of endovascular treatment for intracranial aneurysms has expanded widely. Some centers have started offering only endovascular treatment to patients with intracranial aneurysms (endovascular treatment-only centers [ETOCs]). Our objective was to identify the proportion and outcome of patients treated at ETOCs in the United States. Methods We determined the proportion of ETOCs in the United States using Nationwide Inpatient Survey data files from 2010. We compared short-term outcomes between ETOCs and endovascular and surgical treatment centers (ESTCs). The outcomes studied were none to minimal disability, moderate to severe disability, in-hospital mortality, postprocedure complications, length of stay, and hospital charges. Results Out of 85 hospitals performing endovascular treatment of unruptured aneurysms, 13 (15{\%}) were categorized as ETOCs. Out of the 10,447 patients with unruptured aneurysms, 1245 (12{\%}) were treated at ETOCs. ETOCs were more likely to be nonteaching hospitals (55{\%} versus 45{\%}, P =.02). The rates of in-hospital mortality (1.2{\%} versus 1.8{\%}) and none to minimal disability (88{\%} versus 84{\%}) were similar in patients treated at ETOCs and ESTC hospitals. The mean hospitalization charges were similar, but length of stay (4 ± 7 days versus 6 ± 10 days, P <.0001) was significantly shorter among patients treated at ETOCs. Only 2.7{\%} patients required secondary neurosurgical procedures at the ETOCs compared with 5.8{\%} in ESTCs (P =.09). Conclusion The recent emergence of ETOCs and provision of treatment with comparable outcomes and shorter length of stay at these hospitals may change the pattern of intracranial aneurysm treatment in the United States.",
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AU - Qureshi, Adnan I.

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AB - Background Because of the availability of new technology, the spectrum of endovascular treatment for intracranial aneurysms has expanded widely. Some centers have started offering only endovascular treatment to patients with intracranial aneurysms (endovascular treatment-only centers [ETOCs]). Our objective was to identify the proportion and outcome of patients treated at ETOCs in the United States. Methods We determined the proportion of ETOCs in the United States using Nationwide Inpatient Survey data files from 2010. We compared short-term outcomes between ETOCs and endovascular and surgical treatment centers (ESTCs). The outcomes studied were none to minimal disability, moderate to severe disability, in-hospital mortality, postprocedure complications, length of stay, and hospital charges. Results Out of 85 hospitals performing endovascular treatment of unruptured aneurysms, 13 (15%) were categorized as ETOCs. Out of the 10,447 patients with unruptured aneurysms, 1245 (12%) were treated at ETOCs. ETOCs were more likely to be nonteaching hospitals (55% versus 45%, P =.02). The rates of in-hospital mortality (1.2% versus 1.8%) and none to minimal disability (88% versus 84%) were similar in patients treated at ETOCs and ESTC hospitals. The mean hospitalization charges were similar, but length of stay (4 ± 7 days versus 6 ± 10 days, P <.0001) was significantly shorter among patients treated at ETOCs. Only 2.7% patients required secondary neurosurgical procedures at the ETOCs compared with 5.8% in ESTCs (P =.09). Conclusion The recent emergence of ETOCs and provision of treatment with comparable outcomes and shorter length of stay at these hospitals may change the pattern of intracranial aneurysm treatment in the United States.

KW - coil embolization

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KW - surgical treatment

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