TY - JOUR
T1 - In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases
T2 - a systematic review and meta-analysis
AU - Ikawa, Fusao
AU - Michihata, Nobuaki
AU - Matsushige, Toshinori
AU - Abiko, Masaru
AU - Ishii, Daizo
AU - Oshita, Jumpei
AU - Okazaki, Takahito
AU - Sakamoto, Shigeyuki
AU - Kurogi, Ryota
AU - Iihara, Koji
AU - Nishimura, Kunihiro
AU - Morita, Akio
AU - Fushimi, Kiyohide
AU - Yasunaga, Hideo
AU - Kurisu, Kaoru
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - There has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based on the nationwide databases published from 2007 to 2018. According to this propensity score-matched analysis, no significant association for poor outcome of mRS > 2 was shown between surgical clipping and endovascular coiling (47.7% vs 48.3%, p = 0.48). However, significantly lower in-hospital mortality was revealed after surgical clipping than endovascular coiling (7.1% vs 12.2%, p < 0.001). Meta-analysis of propensity score-matched analysis in the nationwide database showed no significant association for poor outcome at discharge between them (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.93 to 1.26; p = 0.31). Meta-analysis of propensity score-matched analysis for in-hospital mortality was lower after surgical clipping than after endovascular coiling, however, without significant difference (OR, 0.74; 95% CI, 0.52 to 1.04; p = 0.08). Further prospective randomized controlled study with all grade aSAH should be necessary to validate the in-hospital mortality and poor outcome.
AB - There has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based on the nationwide databases published from 2007 to 2018. According to this propensity score-matched analysis, no significant association for poor outcome of mRS > 2 was shown between surgical clipping and endovascular coiling (47.7% vs 48.3%, p = 0.48). However, significantly lower in-hospital mortality was revealed after surgical clipping than endovascular coiling (7.1% vs 12.2%, p < 0.001). Meta-analysis of propensity score-matched analysis in the nationwide database showed no significant association for poor outcome at discharge between them (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.93 to 1.26; p = 0.31). Meta-analysis of propensity score-matched analysis for in-hospital mortality was lower after surgical clipping than after endovascular coiling, however, without significant difference (OR, 0.74; 95% CI, 0.52 to 1.04; p = 0.08). Further prospective randomized controlled study with all grade aSAH should be necessary to validate the in-hospital mortality and poor outcome.
KW - Aneurysmal subarachnoid hemorrhage
KW - Endovascular coiling
KW - In-hospital mortality
KW - Meta-analysis
KW - Nationwide database
KW - Poor outcome
KW - Ruptured cerebral aneurysm
KW - Surgical clipping
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UR - http://www.scopus.com/inward/citedby.url?scp=85064330714&partnerID=8YFLogxK
U2 - 10.1007/s10143-019-01096-2
DO - 10.1007/s10143-019-01096-2
M3 - Article
C2 - 30941595
AN - SCOPUS:85064330714
SN - 0344-5607
VL - 43
SP - 655
EP - 667
JO - Neurosurgical Review
JF - Neurosurgical Review
IS - 2
ER -