scholarly journals Impact of Clipping versus Coiling on Postoperative Hemodynamics and Pulmonary Edema after Subarachnoid Hemorrhage

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Nobutaka Horie ◽  
Mitsutoshi Iwaasa ◽  
Eiji Isotani ◽  
Shunsuke Ishizaka ◽  
Tooru Inoue ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pulmonary Edema ◽  
Medical Information ◽  
Early Period ◽  
Resistance Index ◽  
University Hospital ◽  
Volume Index ◽  
Endovascular Coiling ◽  
Pulmonary Vascular Permeability ◽  
The Impact

Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF), cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP) level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information NetworkUMIN000003794.

Costs of Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 345-352 ◽  
Author(s):  
Chia-Hung Chou ◽  
Shelby D. Reed ◽  
Jennifer S. Allsbrook ◽  
Janet L. Steele ◽  
Kevin A. Schulman ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Endovascular Coiling ◽  
Billing Data ◽  
Surgical Clipping ◽  
Physician Billing ◽  
Symptomatic Vasospasm ◽  
Hospital Stays ◽  
The Impact

Abstract OBJECTIVE To assess the impact of vasospasm on costs, length of stay, and mortality among inpatients with aneurysmal subarachnoid hemorrhage. METHODS We combined hospital accounting and physician billing data for a consecutive cohort of 198 patients who underwent surgical clipping or endovascular coiling for subarachnoid hemorrhage repair. We considered patients with transcranial Doppler (TCD) velocity of 120 cm/s or greater in the middle cerebral artery to have TCD-defined vasospasm and patients with delayed ischemic neurological deficit to have symptomatic vasospasm. We compared outcomes of patients with TCD-defined vasospasm (n = 116) and those without (n = 73) and patients with symptomatic vasospasm (n = 62) and those without (n = 127), adjusting for demographic and clinical characteristics. RESULTS In adjusted analyses, the incremental cost attributable to TCD-defined vasospasm was 1.20 times higher (95% confidence interval, 1.06–1.36; P = .004) than for patients without TCD-defined vasospasm. Length of stay was an estimated 1.22 times longer for patients with TCD-defined vasospasm (95% CI, 1.07–1.39; P < .01). For symptomatic vasospasm, adjusted costs were 1.27 times higher (95% CI, 1.12–1.43; P < .001) and length of stay was an estimated 1.24 times longer (95% CI, 1.09–1.40; P < .01) for patients with vasospasm than for those without. There was no significant relationship between either type of vasospasm and in-hospital mortality. CONCLUSION Patients with subarachnoid hemorrhage and TCD-defined or symptomatic vasospasm incur higher inpatient costs and longer hospital stays than those without vasospasm.

In-hospital complication–related risk factors for discharge and 90-day outcomes in patients with aneurysmal subarachnoid hemorrhage after surgical clipping and endovascular coiling: a propensity score–matched analysis

2021 ◽  
pp. 1-12
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hospital Charges ◽  
Treatment Modalities ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Prediction Ability ◽  
The Impact

OBJECTIVE More than 10 years have passed since the two best-known clinical trials of ruptured aneurysms (International Subarachnoid Aneurysm Trial [ISAT] and Barrow Ruptured Aneurysm Trial [BRAT]) indicated that endovascular coiling (EC) was superior to surgical clipping (SC). However, in recent years, the development of surgical techniques has greatly improved; thus, it is necessary to reanalyze the impact of the differences in treatment modalities on the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS The authors retrospectively reviewed all aSAH patients admitted to their institution between January 2015 and December 2020. The functional outcomes at discharge and 90 days after discharge were assessed using the modified Rankin Scale (mRS). In-hospital complications, hospital charges, and risk factors derived from multivariate logistic regression were analyzed in the SC and EC groups after 1:1 propensity score matching (PSM). The area under the receiver operating characteristic curve was used to calculate each independent predictor’s prediction ability between treatment groups. RESULTS A total of 844 aSAH patients were included. After PSM to control for sex, aneurysm location, Hunt and Hess grade, World Federation of Neurosurgical Societies (WFNS) grade, modified Fisher Scale grade, and current smoking and alcohol abuse status, 329 patients who underwent SC were compared with 329 patients who underwent EC. Patients who underwent SC had higher incidences of unfavorable discharge and 90-day outcomes (46.5% vs 33.1%, p < 0.001; and 19.6% vs 13.8%, p = 0.046, respectively), delayed cerebral ischemia (DCI) (31.3% vs 20.1%, p = 0.001), intracranial infection (20.1% vs 1.2%, p < 0.001), anemia (42.2% vs 17.6%, p < 0.001), hypoproteinemia (46.2% vs 21.6%, p < 0.001), and pneumonia (33.4% vs 24.9%, p = 0.016); but a lower incidence of urinary tract infection (1.2% vs 5.2%, p = 0.004) and lower median hospital charges ($12,285 [IQR $10,399–$15,569] vs $23,656 [IQR $18,816–$30,025], p < 0.001). A positive correlation between the number of in-hospital complications and total hospital charges was indicated in the SC (r = 0.498, p < 0.001) and EC (r = 0.411, p < 0.001) groups. The occurrence of pneumonia and DCI, WFNS grade IV or V, and age were common independent risk factors for unfavorable outcomes at discharge and 90 days after discharge in both treatment modalities. CONCLUSIONS EC shows advantages in discharge and 90-day outcomes, in-hospital complications, and the number of risk factors but increases the economic cost on patients during their hospital stay. Severe in-hospital complications such as pneumonia and DCI may have a long-lasting impact on the prognosis of patients.

scholarly journals Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for subarachnoid hemorrhage

2017 ◽  
Vol 126 (3) ◽  
pp. 805-810 ◽  
Author(s):  
Kimon Bekelis ◽  
Daniel J. Gottlieb ◽  
Yin Su ◽  
Giuseppe Lanzino ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Instrumental Variable ◽  
Cerebral Aneurysms ◽  
Treatment Method ◽  
Cost Of Care ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unmeasured Confounding ◽  
The Impact

OBJECTIVE The impact of treatment method—surgical clipping or endovascular coiling—on the cost of care for patients with aneurysmal subarachnoid hemorrhage (SAH) is debated. Here, the authors investigated the association between treatment method and long-term Medicare expenditures in elderly patients with aneurysmal SAH. METHODS The authors performed a cohort study of 100% of the Medicare fee-for-service claims data for elderly patients who had undergone treatment for ruptured cerebral aneurysms in the period from 2007 to 2012. To control for measured confounding, the authors used propensity score–adjusted multivariable regression analysis with mixed effects to account for clustering at the hospital referral region (HRR) level. An instrumental variable (regional rates of coiling) analysis was used to control for unmeasured confounding by creating pseudo-randomization on the treatment method. RESULTS During the study period, 3210 patients underwent treatment for ruptured cerebral aneurysms and met the inclusion criteria. Of these patients, 1206 (37.6%) had surgical clipping and 2004 (62.4%) had endovascular coiling. The median total Medicare expenditures in the 1st year after admission for SAH were $113,000 (IQR $77,500–$182,000) for surgical clipping and $103,000 (IQR $72,900–$159,000) for endovascular coiling. When the authors adjusted for unmeasured confounders by using an instrumental variable analysis, clipping was associated with increased 1-year Medicare expenditures by $19,577 (95% CI $4492–$34,663). CONCLUSIONS In a cohort of Medicare patients with aneurysmal SAH, after controlling for unmeasured confounding, surgical clipping was associated with increased 1-year expenditures in comparison with endovascular coiling.

scholarly journals Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

2015 ◽  
Vol 122 (2) ◽  
pp. 408-413 ◽  
Author(s):  
Christian Fung ◽  
Mathias Balmer ◽  
Michael Murek ◽  
Werner J. Z'Graggen ◽  
Janine Abu-Isa ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Early Onset ◽  
Demographic Data ◽  
University Hospital ◽  
World Federation ◽  
Poor Grade ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Impact

OBJECT After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. METHODS This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I–III) and poor (WFNS IV–V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0–3 was considered a good outcome and an mRS score of 4–6 was considered a poor outcome. RESULTS Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14–7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63–10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. CONCLUSIONS Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.

scholarly journals Impact of the Clinical Trials Act on noncommercial clinical research in Japan: An interrupted time-series analysis

2021 ◽  
Author(s):  
Ikuyo Tsutsumi ◽  
Yusuke Tsutsumi ◽  
Chikashi Yoshida ◽  
Takuya Komeno ◽  
Yuichi Imanaka
Keyword(s):  
Clinical Trial ◽  
Time Series ◽  
Clinical Trials ◽  
Clinical Studies ◽  
Medical Information ◽  
Interrupted Time Series ◽  
University Hospital ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
The Impact

AbstractBackgroundThe number of new noncommercial clinical studies conducted in Japan declined within the first year of the implementation of the Clinical Trials Act (CTA) on April 1, 2018. This study aimed to examine the impact of the CTA’s enforcement on the number of new noncommercial clinical studies registered in the Japanese Clinical Trial Registry.MethodsAn interrupted time-series design was used in the analysis, which was conducted for the period of April 2015 to March 2019. We collected data for trials registered in the Clinical Trial Registry, managed by the University Hospital Medical Information Network.ResultsIn total, 35,811 studies were registered in the registry; of these, 16,455 fulfilled the eligibility criteria. The difference in the trend of monthly number of new trials after CTA enforcement decreased significantly by 15.0 trials (95% CI, −18.7 to −11.3), and the level decreased by 40.8 (95% CI, −68.2 to −13.3) from the pre-enforcement to the post-enforcement period. Multigroup analyses indicated that the act exerted a significant effect on the trend of new clinical trials, particularly those with smaller sample sizes, interventional study designs, and nonprofit funding sponsors.ConclusionsThe number of Japanese noncommercial clinical studies declined significantly following implementation of the CTA. It is necessary to establish a system to promote clinical studies in Japan while ensuring transparency and safety.

Abstract TP423: Postoperative Hemodynamics is Different between Clipping and Coiling after Aneurismal Subarachnoid Hemorrhage -A Multicenter Prospective Cohort Study -

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nobutaka Horie ◽  
Mitsutoshi Iwaasa ◽  
Eiji Isotani ◽  
Shunsuke Ishizaka ◽  
Tooru Inoue ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Endovascular Coiling ◽  
Lung Edema ◽  
Pulmonary Vascular Permeability ◽  
Volume Management ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Background and Purpose: Volume management is critical for the assessment of the vasospasm after aneurismal subarachnoid hemorrhage (SAH). In this study, we investigate the difference in the postoperative systemic hemodynamics between surgical clipping and endovascular coiling. Methods: In a multicenter prospective cohort study, multiple hemodynamic parameters were calculated by single indicator transpulmonary thermodilution system (Picco®) from day 1 to 14 in the patients with SAH. Results: Two hundred and four patients were enrolled in this study, and 176 patients with ruptured anterior circulation aneurysm were analyzed. Clipping was performed in 155 patients and coiling was performed in 21 patients. The patient characteristics were similar in both groups except higher preoperative grade in coiling than clipping. Regarding hematological parameters, clipping group had higher CRP and lower hemoglobin and hematocrits. Preload and afterload were similar in both groups. Coiling group had significantly less cardiac function index compared with clipping indicating that coiling was preferably selected for severe cases. Interestingly, extravascular lung water index (EVLWI) was significantly higher in clipping than coiling group without elevation of the pulmonary vascular permeability index. Moreover, elevation of Brain Natriuretic Peptide did not affect EVLWI. Conclusions: We first show that postoperative hemodynamics is different depending on the treatment option: clipping or coiling after aneurysmal SAH. Clipping can enhances cardiogenic lung edema due to hemodynamic stress rather than coiling. Bedside monitoring with Picco® system is a powerful tool for the volume management of patients with SAH.

scholarly journals Association between statistical significance and time to publication among systematic reviews: a study protocol for a meta-epidemiological investigation

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018856 ◽  
Author(s):  
Yasushi Tsujimoto ◽  
Yusuke Tsutsumi ◽  
Yuki Kataoka ◽  
Hiraku Tsujimoto ◽  
Yosuke Yamamoto ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Medical Information ◽  
Statistical Significance ◽  
Journal Article ◽  
Time Lag ◽  
University Hospital ◽  
Protocol Registration ◽  
Registration Number ◽  
The Impact

IntroductionMany studies have indicated the impact of bias in dissemination and publication in medical research. Existence of such bias among clinical trials has been repeatedly pointed out, but it has not been well studied in the field of systematic reviews (SRs). We therefore aim to investigate whether or not time lag bias and publication bias in SRs based on statistical significance in results exist. In addition, we will examine at what stage of paper publication process such bias, if any, creeps in.Method and analysisThe present study is a meta-epidemiological study. We will include all SRs of interventions registered in the international prospective register of SRs (PROSPERO) before December 2014 if the SR has completed its analysis irrespective of its publication status. All contact authors of eligible SRs will be asked to participate in a survey administered through the Internet. Our primary outcome is time from protocol registration to full publication of SR as a journal article, defined as time from the registration date to the acceptance date among all the relevant SRs. We will examine the impact of statistically significant findings on the primary outcomes through time to event analyses.Ethics and disseminationEthics approval will be obtained from the Ethical Committee of the Kyoto University Graduate School of Medicine. This protocol has been registered in the University Hospital Medical Information Network Clinical Trials Registry. We will publish our findings in a peer-reviewed journal and also may present them at conferences. Trial registration number:UMIN000028325

Hospital Informatization in China During the COVID-19 Pandemic: A Cross-Sectional Internet-Based Survey Study (Preprint)

2020 ◽  
Author(s):  
Ke Zeng ◽  
Weiguo Zhu ◽  
Caiyou Wang ◽  
Liyan Zhu
Keyword(s):  
Information Technology ◽  
Information Security ◽  
Medical Information ◽  
Survey Study ◽  
Chinese Government ◽  
Qr Code ◽  
Cross Sectional ◽  
Network Information ◽  
Tertiary Hospitals ◽  
The Impact

BACKGROUND The rapid spread of COVID-19 has created a severe challenge to China’s healthcare system. Hospitals across the country reacted quickly under the leadership of the Chinese government and implemented a range of informatization measures to effectively respond to the COVID-19. OBJECTIVE To understand the impact of the pandemic on the medical business of Chinese hospitals and the difficulties faced by hospital informatization construction. To discuss the application of hospital informatization measures during the COVID-19 pandemic. To summarize the practical experience of hospitals using information technology to fight the pandemic. METHODS Performing a cross-sectional on-line questionnaire survey in Chinese hospitals, of which the participants are invited including hospital information staff, hospital administrators, medical staff, etc. Statistical analyzing the collected data by using SPSS version 24. RESULTS A total of 804 valid questionnaires (88.45%) are collected in this study from 30 provinces in mainland China, of which 731 (90.92%) were filled out by hospital information staff. 473 (58.83%) hospitals are tertiary hospitals while the remaining 331 (41.17%) are secondary hospitals. The majority hospitals (82.46%) had a drop in their business volume during the pandemic and a more substantial drop is found in tertiary hospitals. 70.40% (n=566) of hospitals have upgraded or modified their information systems in response to the epidemic. The proportion of tertiary hospitals that upgraded or modified systems is significantly higher than that of secondary hospitals. Internet hospital consultation (70.52%), pre-check and triage (62.56%), telemedicine (60.32%), health QR code (57.71%), and telecommuting (50.87%) are the most used informatization anti-pandemic measures. There are obvious differences in the application of information measures between tertiary hospitals and secondary hospitals. Among these measures, most of them (41.17%) are aiming at serving patients and most of them (62.38%) are universal which continue to be used after pandemic. The informatization measures are mostly used to control the source of infection (48.19%), such as health QR Code, etc. During the pandemic, the main difficulties faced by the hospital information department are “information construction projects are hindered” (58.96%) and “increased difficulty in ensuring network information security” (58.58%). There are significant differences in this issue between tertiary hospitals and secondary hospitals. The shortcomings of hospital informatization that should be made up for are “shorten patient consultation time and optimize consultation process” (72.51%), “Ensure network information security” (72.14%) and “build internet hospital consultations platform” (59.95%). CONCLUSIONS A significant number of innovative medical information technology have been used and played a significant role in all phases of COVID-19 prevention and control in China. Since the COVID-19 brought many challenges and difficulties for informatization work, hospitals need to constantly improve their own information technology skills to respond to public health emergencies that arise at any moment.

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