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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

  • Fusao IkawaEmail author
  • Nobuaki Michihata
  • Toshinori Matsushige
  • Masaru Abiko
  • Daizo Ishii
  • Jumpei Oshita
  • Takahito Okazaki
  • Shigeyuki Sakamoto
  • Ryota Kurogi
  • Koji Iihara
  • Kunihiro Nishimura
  • Akio Morita
  • Kiyohide Fushimi
  • Hideo Yasunaga
  • Kaoru Kurisu
Original Article
  • 58 Downloads

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.

Keywords

Aneurysmal subarachnoid hemorrhage Endovascular coiling In-hospital mortality Meta-analysis Nationwide database Poor outcome Ruptured cerebral aneurysm Surgical clipping 

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

Notes

Authors’ contribution

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.

Funding

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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

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

Systematic reviews and meta-analyses registration

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

The registration ID number for International Prospective Register of Systematic Reviews is 93220.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fusao Ikawa
    • 1
    Email author
  • Nobuaki Michihata
    • 2
  • Toshinori Matsushige
    • 3
  • Masaru Abiko
    • 1
  • Daizo Ishii
    • 1
  • Jumpei Oshita
    • 1
  • Takahito Okazaki
    • 1
  • Shigeyuki Sakamoto
    • 1
  • Ryota Kurogi
    • 4
  • Koji Iihara
    • 4
  • Kunihiro Nishimura
    • 5
  • Akio Morita
    • 6
  • Kiyohide Fushimi
    • 7
  • Hideo Yasunaga
    • 2
  • Kaoru Kurisu
    • 1
  1. 1.Department of Neurosurgery, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  3. 3.Department of Neurosurgery and Interventional NeuroradiologyHiroshima City Asa Citizens HospitalHiroshimaJapan
  4. 4.Department of Neurosurgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  5. 5.Department of Preventive Medicine and Epidemiologic InformaticsNational Cerebral and Cardiovascular CentreSuitaJapan
  6. 6.Department of Neurological SurgeryNippon Medical School HospitalTokyoJapan
  7. 7.Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan

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