Complication-effectiveness analysis for brain arteriovenous malformation surgery: a prospective cohort study

Michael Kerin Morgan, Markus Wiedmann, Nazih N. Assaad, Gillian Z. Heller

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Intervention for brain arteriovenous malformations (bAVMs) should aim at treatment that is safe and effective. OBJECTIVE: To analyze a prospective database to derive the probability of neurological deficit and adjust this risk for effectively treated bAVMs (complication-effectiveness analysis [CEA]). Methods: First, we calculated the percentage of surgical complications leading to a modified Rankin Scale >1 at 12 months after surgery for each Spetzler-Ponce class (SPC). Second, we performed a sensitivity analysis of these results by including bAVMs not undergoing surgery, to correct for bias. Third, we established the long-term cumulative incidence of freedom from recurrence from Kaplan-Meier analysis. Finally, we combined the results to calculate the risk of surgery per effective treatment in a complication-effectiveness analysis. Results: Seven hundred seventy-nine patients underwent 641 microsurgical resections. Complications of surgery leading to a modified Rankin Scale >1 at 12 months occurred in 1.4% (95% confidence interval [CI]: 0.5-3.3), 20% (95% CI: 15-26), and 41% (95% CI: 30-52) of SPC A, SPC B, and SPC C, respectively. The cumulative 9-year freedom from recurrence was 97% for SPC A and 92% for other bAVMs. The 9-year CEA risk was 1.4% (credible range: 0.5%-3.4%) for SPC A, 22% to 24% (credible range: 16%-31%) for SPC B, and 45% to 63% (credible range: 33%-73%) for SPC C bAVM. Conclusion: CEA presents the treatment outcome in the context of efficacy and provides a basis for comparing outcomes from techniques with different times to elimination of the bAVM.

LanguageEnglish
Pages47-57
Number of pages11
JournalNeurosurgery
Volume79
Issue number1
DOIs
Publication statusPublished - 1 Jul 2016

Fingerprint

Arteriovenous Malformations
Cohort Studies
Prospective Studies
Brain
Confidence Intervals
Recurrence
Kaplan-Meier Estimate
Databases
Incidence
Therapeutics

Keywords

  • Arteriovenous malformation
  • Brain
  • Cohort study
  • Risks
  • Surgery

Cite this

Morgan, Michael Kerin ; Wiedmann, Markus ; Assaad, Nazih N. ; Heller, Gillian Z. / Complication-effectiveness analysis for brain arteriovenous malformation surgery : a prospective cohort study. In: Neurosurgery. 2016 ; Vol. 79, No. 1. pp. 47-57.
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abstract = "Background: Intervention for brain arteriovenous malformations (bAVMs) should aim at treatment that is safe and effective. OBJECTIVE: To analyze a prospective database to derive the probability of neurological deficit and adjust this risk for effectively treated bAVMs (complication-effectiveness analysis [CEA]). Methods: First, we calculated the percentage of surgical complications leading to a modified Rankin Scale >1 at 12 months after surgery for each Spetzler-Ponce class (SPC). Second, we performed a sensitivity analysis of these results by including bAVMs not undergoing surgery, to correct for bias. Third, we established the long-term cumulative incidence of freedom from recurrence from Kaplan-Meier analysis. Finally, we combined the results to calculate the risk of surgery per effective treatment in a complication-effectiveness analysis. Results: Seven hundred seventy-nine patients underwent 641 microsurgical resections. Complications of surgery leading to a modified Rankin Scale >1 at 12 months occurred in 1.4{\%} (95{\%} confidence interval [CI]: 0.5-3.3), 20{\%} (95{\%} CI: 15-26), and 41{\%} (95{\%} CI: 30-52) of SPC A, SPC B, and SPC C, respectively. The cumulative 9-year freedom from recurrence was 97{\%} for SPC A and 92{\%} for other bAVMs. The 9-year CEA risk was 1.4{\%} (credible range: 0.5{\%}-3.4{\%}) for SPC A, 22{\%} to 24{\%} (credible range: 16{\%}-31{\%}) for SPC B, and 45{\%} to 63{\%} (credible range: 33{\%}-73{\%}) for SPC C bAVM. Conclusion: CEA presents the treatment outcome in the context of efficacy and provides a basis for comparing outcomes from techniques with different times to elimination of the bAVM.",
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Complication-effectiveness analysis for brain arteriovenous malformation surgery : a prospective cohort study. / Morgan, Michael Kerin; Wiedmann, Markus; Assaad, Nazih N.; Heller, Gillian Z.

In: Neurosurgery, Vol. 79, No. 1, 01.07.2016, p. 47-57.

Research output: Contribution to journalArticleResearchpeer-review

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