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(Stroke. 2004;35:1399.)
© 2004 American Heart Association, Inc.

Original Contributions

Impact of Surgical Clipping on Survival in Unruptured and Ruptured Cerebral Aneurysms

A Population-Based Study

Gavin W. Britz, MD, MPH; Leon Salem, MD; David W. Newell, MD; Joseph Eskridge, MD David R. Flum, MD, MPH

From the Departments of Neurosurgery (G.W.B., D.W.N., J.E.), Radiology (G.W.B., J.E.), Surgery (L.S., D.R.F.), and Health Services (D.R.F.), University of Washington, Seattle, Wash.

Correspondence to Dr David R. Flum, Assistant Professor, University of Washington, Department of Surgery, BB 431, 1959 NE Pacific St, Box 356410, Seattle, WA 98195-6410. E-mail daveflum{at}u.washington.edu

Background and Purpose— The management of aneurysms is controversial because little is known about the impact of clipping on long-term outcome. This study was designed to evaluate long-term survival of patients with aneurysms undergoing clipping in a statewide population.

Methods— We used a retrospective design using an administrative database to identify patients hospitalized with aneurysms (1987 to 2001). Time-to-event analysis was used to determine the risk of death from all causes and from neurological causes.

Results— 4619 patients (mean age 54.7±15.3, 66.3% female) were hospitalized with cerebral aneurysms. Survival among patients with ruptures was significantly lower compared with patients with unruptured aneurysm (P<0.001) with adjusted hazard ratio (HR) of death after clipping 40% higher (HR: 1.4; 95% CI: 1.2, 1.7) in patients with rupture compared with those that were unruptured. Survival estimates for unruptured patients who underwent clipping were significantly higher than among those unruptured patients who did not undergo clipping (P<0.001), with adjusted HR of death 30% higher in patients with unruptured aneurysm that were not clipped compared with unruptured patients who were clipped (HR: 1.3; 95% CI: 1.1, 1.6). Patients with unruptured aneurysm who underwent clipping and survived beyond the 30-day postoperative period were less likely to die from neurologically related causes (5.6 versus 2.3%, P<0.001). Patients with ruptures and aneurysms who underwent clipping have a higher rate of death compared with the general population in the long-term.

Conclusions— Short-term and long-term mortality after clipping of cerebral aneurysms is higher than previously reported. Patients with unruptured aneurysms who undergo clipping have improved survival compared with those who do not undergo clipping. This study supports the use of early intervention in the management of patients with unruptured aneurysms.

Key Words: intracranial pressure • aneurysm • surgery • epidemiology • outcome

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