In-Hospital Morbidity and Mortality after Endovascular Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: Effect of Hospital and Physician Volume

Brian L. Hoh, James D. Rabinov, Johnny C. Pryor, Bob S. Carter and Fred G. Barker II.
American Journal of Neuroradiology 2003 24: 1409-1420

Object: The purpose of the study was to determine the risk of adverse outcomes after contemporary endovascular treatment of unruptured intracranial aneurysms in the United States.

Method: The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample, 1996–2000.

Results: Higher volume hospitals had fewer adverse outcomes; discharge other than to home occurred after 5.2% of operations at high volume hospitals (>23 admissions per year) compared with 17.6% at low volume hospitals (fewer than four admissions per year) (P < .001). Higher physician volume had a similar effect (0% versus 16.4%, P = .03). The mortality rate was lower at high volume hospitals (1.0% versus 3.7%) but not significantly so. At high volume hospitals, length of stay was shorter (P < .001) and total hospital charges were lower (P < .001).

Conclusion: For patients with unruptured aneurysms treated in the United States from 1996 to 2000, endovascular treatment at high volume institutions or by high volume physicians was associated with significantly lower morbidity rates and modestly lower mortality rates. Length of stay was shorter and total hospital charges lower at high volume centers.

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