Complication-effectiveness analysis for unruptured intracranial aneurysm surgery: a prospective cohort study

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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: The aim of intervention for unruptured intracranial aneurysms (UIAs) is safe, effective treatment. OBJECTIVE: To analyze a prospective database for variables influencing the risk of surgery to produce a risk model adjusting this risk for effectively treated aneurysms. METHODS: First, we identified variables to create a model from multiple logistic regression for complications of surgery leading to a 12-month modified Rankin Scale score >1. Second, we established the long-term cumulative incidence of freedom from retreatment or rupture (treated aneurysm) from Kaplan-Meier analysis. Third, we combined these analyses to establish a model of risk of surgery per effective treatment. RESULTS: One thousand twelve patients with 1440 UIA underwent 1080 craniotomies. We found that 10.1% (95% confidence interval [CI], 8.4-12.0) of craniotomies resulted in a complication leading to a modified Rankin Scale score >1 at 12 months. Logistic regression found age (odds ratio, 1.04; 95% CI, 1.02-1.06), size (odds ratio, 1.12; 95% CI, 1.09-1.15), and posterior circulation location (odds ratio, 2.95; 95% CI, 1.82-4.78) to be significant. Cumulative 10-year risk of retreatment or rupture was 3.0% (95% CI, 1.3-7.0). The complication-effectiveness model was derived by dividing the complication risk by the 10-year cumulative freedom from retreatment or rupture proportion. Risk per effective treatment ranged from 1% for a 5-mm anterior circulation UIA in a 20-year-old patient to 70% for a giant posterior circulation UIA in a 70-year-old patient. CONCLUSION: Complication-effectiveness analyses increase the information available with regard to outcome for the management of UIAs. ABBREVIATIONS: CE, complication-effectiveness CI, confidence interval CTA, computed tomographic angiography DSA, digital subtraction angiography ISUIA, International Study of Unruptured Intracranial Aneurysms MRA, magnetic resonance angiography mRS, modified Rankin Scale UIA, unruptured intracranial aneurysm.

LanguageEnglish
Pages648-659
Number of pages12
JournalNeurosurgery
Volume78
Issue number5
DOIs
Publication statusPublished - 1 May 2016

Fingerprint

Intracranial Aneurysm
Cohort Studies
Prospective Studies
Confidence Intervals
Retreatment
Rupture
Craniotomy
Odds Ratio
Aneurysm
Logistic Models
Digital Subtraction Angiography
Magnetic Resonance Angiography
Kaplan-Meier Estimate
Angiography
Therapeutics
Databases
Incidence

Keywords

  • Brain
  • Cohort study
  • Intracranial aneurysm
  • Retreatment
  • Risks
  • Surgery

Cite this

Morgan, Michael Kerin ; Wiedmann, Markus ; Assaad, Nazih N. ; Heller, Gillian Z. / Complication-effectiveness analysis for unruptured intracranial aneurysm surgery : a prospective cohort study. In: Neurosurgery. 2016 ; Vol. 78, No. 5. pp. 648-659.
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title = "Complication-effectiveness analysis for unruptured intracranial aneurysm surgery: a prospective cohort study",
abstract = "BACKGROUND: The aim of intervention for unruptured intracranial aneurysms (UIAs) is safe, effective treatment. OBJECTIVE: To analyze a prospective database for variables influencing the risk of surgery to produce a risk model adjusting this risk for effectively treated aneurysms. METHODS: First, we identified variables to create a model from multiple logistic regression for complications of surgery leading to a 12-month modified Rankin Scale score >1. Second, we established the long-term cumulative incidence of freedom from retreatment or rupture (treated aneurysm) from Kaplan-Meier analysis. Third, we combined these analyses to establish a model of risk of surgery per effective treatment. RESULTS: One thousand twelve patients with 1440 UIA underwent 1080 craniotomies. We found that 10.1{\%} (95{\%} confidence interval [CI], 8.4-12.0) of craniotomies resulted in a complication leading to a modified Rankin Scale score >1 at 12 months. Logistic regression found age (odds ratio, 1.04; 95{\%} CI, 1.02-1.06), size (odds ratio, 1.12; 95{\%} CI, 1.09-1.15), and posterior circulation location (odds ratio, 2.95; 95{\%} CI, 1.82-4.78) to be significant. Cumulative 10-year risk of retreatment or rupture was 3.0{\%} (95{\%} CI, 1.3-7.0). The complication-effectiveness model was derived by dividing the complication risk by the 10-year cumulative freedom from retreatment or rupture proportion. Risk per effective treatment ranged from 1{\%} for a 5-mm anterior circulation UIA in a 20-year-old patient to 70{\%} for a giant posterior circulation UIA in a 70-year-old patient. CONCLUSION: Complication-effectiveness analyses increase the information available with regard to outcome for the management of UIAs. ABBREVIATIONS: CE, complication-effectiveness CI, confidence interval CTA, computed tomographic angiography DSA, digital subtraction angiography ISUIA, International Study of Unruptured Intracranial Aneurysms MRA, magnetic resonance angiography mRS, modified Rankin Scale UIA, unruptured intracranial aneurysm.",
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Complication-effectiveness analysis for unruptured intracranial aneurysm surgery : a prospective cohort study. / Morgan, Michael Kerin; Wiedmann, Markus; Assaad, Nazih N.; Heller, Gillian Z.

In: Neurosurgery, Vol. 78, No. 5, 01.05.2016, p. 648-659.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Complication-effectiveness analysis for unruptured intracranial aneurysm surgery

T2 - Neurosurgery

AU - Morgan, Michael Kerin

AU - Wiedmann, Markus

AU - Assaad, Nazih N.

AU - Heller, Gillian Z.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - BACKGROUND: The aim of intervention for unruptured intracranial aneurysms (UIAs) is safe, effective treatment. OBJECTIVE: To analyze a prospective database for variables influencing the risk of surgery to produce a risk model adjusting this risk for effectively treated aneurysms. METHODS: First, we identified variables to create a model from multiple logistic regression for complications of surgery leading to a 12-month modified Rankin Scale score >1. Second, we established the long-term cumulative incidence of freedom from retreatment or rupture (treated aneurysm) from Kaplan-Meier analysis. Third, we combined these analyses to establish a model of risk of surgery per effective treatment. RESULTS: One thousand twelve patients with 1440 UIA underwent 1080 craniotomies. We found that 10.1% (95% confidence interval [CI], 8.4-12.0) of craniotomies resulted in a complication leading to a modified Rankin Scale score >1 at 12 months. Logistic regression found age (odds ratio, 1.04; 95% CI, 1.02-1.06), size (odds ratio, 1.12; 95% CI, 1.09-1.15), and posterior circulation location (odds ratio, 2.95; 95% CI, 1.82-4.78) to be significant. Cumulative 10-year risk of retreatment or rupture was 3.0% (95% CI, 1.3-7.0). The complication-effectiveness model was derived by dividing the complication risk by the 10-year cumulative freedom from retreatment or rupture proportion. Risk per effective treatment ranged from 1% for a 5-mm anterior circulation UIA in a 20-year-old patient to 70% for a giant posterior circulation UIA in a 70-year-old patient. CONCLUSION: Complication-effectiveness analyses increase the information available with regard to outcome for the management of UIAs. ABBREVIATIONS: CE, complication-effectiveness CI, confidence interval CTA, computed tomographic angiography DSA, digital subtraction angiography ISUIA, International Study of Unruptured Intracranial Aneurysms MRA, magnetic resonance angiography mRS, modified Rankin Scale UIA, unruptured intracranial aneurysm.

AB - BACKGROUND: The aim of intervention for unruptured intracranial aneurysms (UIAs) is safe, effective treatment. OBJECTIVE: To analyze a prospective database for variables influencing the risk of surgery to produce a risk model adjusting this risk for effectively treated aneurysms. METHODS: First, we identified variables to create a model from multiple logistic regression for complications of surgery leading to a 12-month modified Rankin Scale score >1. Second, we established the long-term cumulative incidence of freedom from retreatment or rupture (treated aneurysm) from Kaplan-Meier analysis. Third, we combined these analyses to establish a model of risk of surgery per effective treatment. RESULTS: One thousand twelve patients with 1440 UIA underwent 1080 craniotomies. We found that 10.1% (95% confidence interval [CI], 8.4-12.0) of craniotomies resulted in a complication leading to a modified Rankin Scale score >1 at 12 months. Logistic regression found age (odds ratio, 1.04; 95% CI, 1.02-1.06), size (odds ratio, 1.12; 95% CI, 1.09-1.15), and posterior circulation location (odds ratio, 2.95; 95% CI, 1.82-4.78) to be significant. Cumulative 10-year risk of retreatment or rupture was 3.0% (95% CI, 1.3-7.0). The complication-effectiveness model was derived by dividing the complication risk by the 10-year cumulative freedom from retreatment or rupture proportion. Risk per effective treatment ranged from 1% for a 5-mm anterior circulation UIA in a 20-year-old patient to 70% for a giant posterior circulation UIA in a 70-year-old patient. CONCLUSION: Complication-effectiveness analyses increase the information available with regard to outcome for the management of UIAs. ABBREVIATIONS: CE, complication-effectiveness CI, confidence interval CTA, computed tomographic angiography DSA, digital subtraction angiography ISUIA, International Study of Unruptured Intracranial Aneurysms MRA, magnetic resonance angiography mRS, modified Rankin Scale UIA, unruptured intracranial aneurysm.

KW - Brain

KW - Cohort study

KW - Intracranial aneurysm

KW - Retreatment

KW - Risks

KW - Surgery

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DO - 10.1227/NEU.0000000000001113

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