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In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis

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Abstract

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.

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Abbreviations

AcomA:

anterior communicating artery

ACA:

anterior cerebral artery

EC:

endovascular coiling

ICA:

internal carotid artery

JCS:

Japan Coma Scale

MCA:

middle cerebral artery

mRS:

modified Rankin Scale

PS:

Propensity score

SAH:

subarachnoid hemorrhage

SC:

surgical clipping

SD:

standard deviation

SE:

standard error

USA:

United States of America

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Funding

This work was supported by the Japan Society for the Promotion of Science, Grant-in-Aid for Scientific Research (C) 17K10829.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Fusao Ikawa, Masaru Abiko, Daizo Ishii, Jumpei Oshita, Takahito Okazaki, Shigeyuki Sakamoto & Kaoru Kurisu

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Nobuaki Michihata & Hideo Yasunaga

  3. Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Toshinori Matsushige

  4. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Ryota Kurogi & Koji Iihara

  5. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan

    Kunihiro Nishimura

  6. Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan

    Akio Morita

  7. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan

    Kiyohide Fushimi

Authors
  1. Fusao Ikawa
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All authors have made substantial contributions to the intellectual content of the paper, contributed to data interpretation, approved the final manuscript, and agree with submission to this journal.

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Correspondence to Fusao Ikawa.

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The authors declare that they have no conflict of interest.

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The present study was approved by the Institutional Review Board of Hiroshima University (No. E-629).

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The requirement for informed consent was waived because of the anonymous nature of the data and the opt out method.

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Ikawa, F., Michihata, N., Matsushige, T. et al. In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis. Neurosurg Rev 43, 655–667 (2020). https://doi.org/10.1007/s10143-019-01096-2

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