Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases.
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Drexler Richard, Sauvigny Thomas, Pantel Tobias F, Ricklefs Franz L, Catapano Joshua S, Wanebo John E, Lawton Michael T, Sanchin Aminaa, Hecht Nils, Vajkoczy Peter, Raygor Kunal, Tonetti Daniel, Abla Adib, El Naamani Kareem, Tjoumakaris Stavropoula I, Jabbour Pascal, Jankowitz Brian T, Salem Mohamed M, Burkhardt Jan-Karl, Wagner Arthur, Wostrack Maria, Gempt Jens, Meyer Bernhard, Gaub Michael, Mascitelli Justin R, Dodier Philippe, Bavinzski Gerhard, Roessler Karl, Stroh Nico, Gmeiner Matthias, Gruber Andreas, Figueiredo Eberval G, da Silva Coelho Antonio Carlos Samaia, Bervitskiy Anatoliy V, Anisimov Egor D, Rzaev Jamil A, Krenzlin Harald, Keric Naureen, Ringel Florian, Park Dougho, Kim Mun-Chul, Marcati Eleonora, Cenzato Marco, Westphal Manfred, Dührsen Lasse
Аннотация
METHODS: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately.
RESULTS: Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients.
CONCLUSION: This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA. These benchmark cutoffs can serve as reference values for other centers, patient registries, and for comparing the benefit of other interventions or novel surgical techniques.