J Korean Med Sci.  2024 Jun;39(23):e188. 10.3346/jkms.2024.39.e188.

Clinical Outcomes of Clipping and Coil Embolization for Ruptured Intracranial Aneurysms Categorized by Region and Hospital Size: A Nationwide Cohort Study in Korea

• Won YD
• Byoun HS
• Choi TW
• Lee SH
• Kim YD
• Ban SP
• Bang JS
• Kwon OK
• Oh CW
• Lee SU

• KMID: 2556682
• DOI: http://doi.org/10.3346/jkms.2024.39.e188

Abstract

Background
To analyze the outcomes of clipping and coiling for ruptured intracranial aneurysms (RIAs) based on data from the National Health Insurance Service in South Korea, with a focus on variations according to region and hospital size.
Methods
This study analyzed the one-year mortality rates for patients with RIAs who underwent clipping or coiling in 2018. Coiling was further categorized into non-stent assisted coiling (NSAC) and stent assisted coiling (SAC). Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs), or semi-general hospitals (sGHs) based on size. South Korea’s administrative districts were divided into 15 regions for analysis.
Results
In 2018, there were 2,194 (33.1%) clipping procedures (TRGH, 985; GH, 827; sGH, 382) and 4,431 (66.9%) coiling procedures (TRGH, 1,642; GH, 2076; sGH, 713) performed for RIAs treatment. Among hospitals performing more than 20 treatments, the one-year mortality rates following clipping or coiling were 11.2% and 16.0%, respectively, with no significant difference observed. However, there was a significant difference in one-year mortality between NSAC and SAC (14.3% vs. 19.5%, P = 0.034), with clipping also showing significantly lower mortality compared to SAC (P = 0.019). No significant differences in other treatment modalities were observed according to hospital size, but clipping at TRGHs had significantly lower mortality than at GHs (P = 0.042). While no significant correlation was found between the number of treatments and outcomes at GHs, at TRGHs, a higher volume of clipping procedures was significantly associated with lower total mortality (P = 0.023) and mortality after clipping (P = 0.022).
Conclusion
Using Korea NHIS data, mortality rates for RIAs showed no significant variation by hospital size due to coiling’s prevalence. However, differences in clipping outcomes by hospital size and volume in TRGH highlight the need for national efforts to improve clipping skills and standardization. Additionally, the higher mortality rate with SAC emphasizes the importance of precise indications for its application.

Keyword

Intracranial Aneurysm; Subarachnoid Hemorrhage; Mortality; Korea

Figure

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  Fig. 1 Analysis of the correlation between the number of treatments and 1-year mortality at TRGH that performed more than 20 RIAs treatments. (A) As the number of clipping procedures for RIAs increased, both the total 1-year mortality (P = 0.023; rho = −0.368) and the one-year mortality after clipping (P = 0.022; rho = −0.370) significantly decreased. (B) There was no significant correlation between the number of coiling procedures performed and treatment outcomes.TRGH = tertiary referral general hospital, RIA = ruptured intracranial aneurysm.

• 

  Fig. 2 Analysis of the correlation between the number of treatments and 1-year mortality at GH that performed more than 20 RIAs treatments. (A) There was no significant correlation between the number of clipping procedures performed and treatment outcomes. (B) A higher volume of coilings at a GH was associated with increased total one-year mortality (P = 0.009; rho = 0.417), but there was no significant correlation with 1-year mortality after coiling (P = 0.559; rho = 0.098).GH = general hospital, RIA = ruptured intracranial aneurysm.

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