Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases

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Citações na Scopus
2
Tipo de produção
article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
Dimensions
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
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
Citação
NEUROSURGERY, v.94, n.2, p.369-378, 2024
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND AND OBJECTIVES: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. 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.
Palavras-chave
Aneurysm, UIA, Outcome, Clipping, Microsurgery, Microsurgical
URI
https://observatorio.fm.usp.br/handle/OPI/58914
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MNE