Microsurgical clipping versus endovascular coiling in pediatric subarachnoid hemorrhage: Insights from the national readmissions database.

BACKGROUND

Microsurgical clipping (SC) and endovascular coiling (EC) are both utilized in the management of ruptured intracranial aneurysms in pediatric patients presenting with non-traumatic aneurysmal subarachnoid hemorrhage (SAH). Data regarding the comparative safety of these techniques is limited. In this study, we aimed to evaluate the clinical outcomes of SC versus EC in pediatric patients presenting with non-traumatic SAH.

METHODS

Pediatric hospitalizations undergoing surgical intervention for non-traumatic SAH were identified from the Nationwide Readmissions Database, 2016-2018. Hospitalizations with a concomitant diagnosis of arterio-venous malformation, cerebral arteritis, and traumatic SAH were excluded. Logistic and linear regression analyses were performed to compare the outcomes between SC and EC. Survival analysis was used to evaluate 30-day non-elective readmissions.

RESULTS

Two-hundred-thirty-eight patients met the inclusion criteria (mean ± SD age: 10.8 ± 6.4 years; female: 46.8 %). Of these, 81 (34.0 %) patients underwent SC and 157 (66.0 %) underwent EC. There were no statistically significant differences in the baseline demographics, clinical presentation, and hospital-level characteristics between the two groups. Clinical outcomes including ischemic stroke, seizures, prolonged intubation, acute cardiac complications, venous thromboembolism, infections, length of hospital stay, in-hospital mortality, and discharge disposition were similar between the two groups. Further, 14 patients were readmitted within 30 days of discharge due to a non-elective reason (mean ± SD time to readmission: 17.2 ± 8.0 days). Patients with EC were less likely to get readmitted, however, the difference was not statistically significant (HR: 0.5, 95 % CI: 0.1-2.3). While most of the readmissions were due to non-neurologic etiology, 29 % were due to hydrocephalus or post-surgical complications.

CONCLUSIONS

The safety profiles of SC and EC for the treatment of aneurysmal SAH in pediatric patients were comparable.