Article
Trends in the treatment of intracranial aneurysms in Austria 1999-2008 – A population-based study using administrative data
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Authors
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Martin Ortler
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria
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Gerhard Fülöp
- Österreichisches Bundesinstitut für Gesundheitswesen (ÖBIG), Wien, Austria
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Claudius Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria
| Published: | September 16, 2010 |
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Outline
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Objective: To describe population-based trends in incidence, treatment modality and outcome for ruptured and unruptured intracranial aneurysms (IAs) in Austria using administrative data.
Methods: Cases of IAs in Austria detected between January 1999 and December 2008 were identified using the public health services database by cross-searching for ICD-10 Codes I60.- (subarachnoid hemorrhage), I61.- (intracerebral hemorrhage) and I67.1 (cerebral aneurysm, nonruptured) and relevant diagnosis-related groups among all patients admitted to Austrian public hospitals. Main outcome parameters were population-based incidence, treatment modality as coded and treatment results (categorised into sent home, discharged other than home, and died in the hospital during the same admission period).
Results: The absolute number of all treated aneurysms was n=504 in 1999 and n=705 in 2008 (plus 38%). The number of ruptured aneurysms remained constant (n=404 in 1999, n= 416 in 2008), the number of unruptured intracranial aneurysms increased steadily (n=123 in 1999, n= 331 in 2008, plus 169%). The rate of UIAs treated by endovascular means and those treated surgically remained constant (endovascular n=68, 55.2% vs. surgical n=55, 44.7% in 1999; endovascular n=177, 53.6% vs. surgical n=153, 46.3% in 2008) For ruptured aneurysms, a marked trend towards endovascular methods was evident (endovascular n=123, 30.5% vs. microsurgical n=279, 69.4% in 1999, endovascular n=240, 57.6% vs. microsurgical n=176, 42.3% in 2008). In-house mortality after treatment of unruptured aneurysms ranged between 0% and 2.9% with endovascular methods and 0% and 4.5% with microsurgical methods. After bleeding, in-house mortality ranged between 8.3% and 19.5% after endovascular and 8.9% and 17.5% after surgical therapy. In-house mortality over the last decade for UIAs was 2.4% in 1999 and 0.6% in 2008 and for ruptured aneurysms 15.9% in 1999 and 12.7% in 2008, respectively
Conclusions: The number of ruptured aneurysms has remained constant over the last decade. The observed increase is due to the rising numbers of UIAs being treated. For ruptured aneurysms, endovascular treatment became the prominent treatment by 2007. A marked decline of in-house mortality was observed for unruptured aneuysms, but not for ruptured aneurysms. Administrative data might prove useful for epidemiological and effectiveness studies.
