Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Abstract

OBJECT.: Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments.

Methods: The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations.

Results: A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97-6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03-0.46; p = 0.001).

Conclusions: Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

Keywords: CCI = Charlson Comorbidity Index; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; ISAT = International Subarachnoid Aneurysm Trial; KID = Kids' Inpatient Database; Kids' Inpatient Database; OR = odds ratio; ZIP = Zone Improvement Plan; cerebral aneurysm; endovascular coiling; outcome; surgical clipping; vascular disorders.