Treatment Risk for Elderly Patients with Unruptured Cerebral Aneurysm from a Nationwide Database in Japan

Fusao Ikawa, Nobuaki Michihata, Yasuhiko Akiyama, Koji Iihara, Fumihiro Matano, Akio Morita, Yoko Kato, Koji Iida, Kaoru Kurisu, Kiyohide Fushimi, Hideo Yasunaga

Research output: Contribution to journalArticle

Abstract

Background: This study aimed to clarify the risk factors of treatment for unruptured cerebral aneurysms (UCAs) in elderly patients by comparing the morbidity at discharge between surgical clipping and endovascular coiling in nonelderly (<65 years) and elderly (≥65 years) patients based on a national database in Japan. Methods: A total of 36,017, including 15,671 patients with UCA after exclusion of unknown location, were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. Outcome of Barthel Index at discharge was investigated and multivariate logistic regression analysis identified risk factors for morbidity of Barthel Index <90 at discharge in nonelderly and elderly patient groups. Results: Risk factors for morbidity at discharge were basilar artery aneurysm compared with internal carotid artery (ICA), diabetes mellitus (odds ratio [OR], 2.0–2.5; 95% confidence interval [CI], 1.6–3.7), antiplatelet drug, and anticoagulation drug; however, highest hospital volume compared with lowest was an inverse risk factor in both age groups. Endovascular coiling (OR, 0.4; 95% CI, 0.3–0.5) was a significantly inverse risk in the elderly group. Anterior communicating artery aneurysm compared with ICA was a significant risk (OR, 1.6; 95% CI, 1.0–2.6) in the nonelderly group; on the other hand, anterior communicating artery aneurysm (OR, 0.7; 95% CI, 0.5–0.95) and middle cerebral artery aneurysm (OR, 0.6; 95% CI, 0.5–0.8) compared with ICA were significantly inverse risks in the elderly group. Conclusions: Endovascular coiling after control of diabetes mellitus was recommended for the treatment of UCA in elderly patients. The ICA location of aneurysm in the elderly should be paid attention as the treatment risk.

Original languageEnglish
Pages (from-to)e89-e98
JournalWorld Neurosurgery
Volume132
DOIs
Publication statusPublished - Dec 2019

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Intracranial Aneurysm
Japan
Databases
Odds Ratio
Internal Carotid Artery
Confidence Intervals
Morbidity
Therapeutics
Diabetes Mellitus
High-Volume Hospitals
Platelet Aggregation Inhibitors
Aneurysm
Age Groups
Logistic Models
Regression Analysis
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Treatment Risk for Elderly Patients with Unruptured Cerebral Aneurysm from a Nationwide Database in Japan. / Ikawa, Fusao; Michihata, Nobuaki; Akiyama, Yasuhiko; Iihara, Koji; Matano, Fumihiro; Morita, Akio; Kato, Yoko; Iida, Koji; Kurisu, Kaoru; Fushimi, Kiyohide; Yasunaga, Hideo.

In: World Neurosurgery, Vol. 132, 12.2019, p. e89-e98.

Research output: Contribution to journalArticle

Ikawa, F, Michihata, N, Akiyama, Y, Iihara, K, Matano, F, Morita, A, Kato, Y, Iida, K, Kurisu, K, Fushimi, K & Yasunaga, H 2019, 'Treatment Risk for Elderly Patients with Unruptured Cerebral Aneurysm from a Nationwide Database in Japan', World Neurosurgery, vol. 132, pp. e89-e98. https://doi.org/10.1016/j.wneu.2019.08.252
Ikawa, Fusao ; Michihata, Nobuaki ; Akiyama, Yasuhiko ; Iihara, Koji ; Matano, Fumihiro ; Morita, Akio ; Kato, Yoko ; Iida, Koji ; Kurisu, Kaoru ; Fushimi, Kiyohide ; Yasunaga, Hideo. / Treatment Risk for Elderly Patients with Unruptured Cerebral Aneurysm from a Nationwide Database in Japan. In: World Neurosurgery. 2019 ; Vol. 132. pp. e89-e98.
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abstract = "Background: This study aimed to clarify the risk factors of treatment for unruptured cerebral aneurysms (UCAs) in elderly patients by comparing the morbidity at discharge between surgical clipping and endovascular coiling in nonelderly (<65 years) and elderly (≥65 years) patients based on a national database in Japan. Methods: A total of 36,017, including 15,671 patients with UCA after exclusion of unknown location, were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. Outcome of Barthel Index at discharge was investigated and multivariate logistic regression analysis identified risk factors for morbidity of Barthel Index <90 at discharge in nonelderly and elderly patient groups. Results: Risk factors for morbidity at discharge were basilar artery aneurysm compared with internal carotid artery (ICA), diabetes mellitus (odds ratio [OR], 2.0–2.5; 95{\%} confidence interval [CI], 1.6–3.7), antiplatelet drug, and anticoagulation drug; however, highest hospital volume compared with lowest was an inverse risk factor in both age groups. Endovascular coiling (OR, 0.4; 95{\%} CI, 0.3–0.5) was a significantly inverse risk in the elderly group. Anterior communicating artery aneurysm compared with ICA was a significant risk (OR, 1.6; 95{\%} CI, 1.0–2.6) in the nonelderly group; on the other hand, anterior communicating artery aneurysm (OR, 0.7; 95{\%} CI, 0.5–0.95) and middle cerebral artery aneurysm (OR, 0.6; 95{\%} CI, 0.5–0.8) compared with ICA were significantly inverse risks in the elderly group. Conclusions: Endovascular coiling after control of diabetes mellitus was recommended for the treatment of UCA in elderly patients. The ICA location of aneurysm in the elderly should be paid attention as the treatment risk.",
author = "Fusao Ikawa and Nobuaki Michihata and Yasuhiko Akiyama and Koji Iihara and Fumihiro Matano and Akio Morita and Yoko Kato and Koji Iida and Kaoru Kurisu and Kiyohide Fushimi and Hideo Yasunaga",
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AU - Ikawa, Fusao

AU - Michihata, Nobuaki

AU - Akiyama, Yasuhiko

AU - Iihara, Koji

AU - Matano, Fumihiro

AU - Morita, Akio

AU - Kato, Yoko

AU - Iida, Koji

AU - Kurisu, Kaoru

AU - Fushimi, Kiyohide

AU - Yasunaga, Hideo

PY - 2019/12

Y1 - 2019/12

N2 - Background: This study aimed to clarify the risk factors of treatment for unruptured cerebral aneurysms (UCAs) in elderly patients by comparing the morbidity at discharge between surgical clipping and endovascular coiling in nonelderly (<65 years) and elderly (≥65 years) patients based on a national database in Japan. Methods: A total of 36,017, including 15,671 patients with UCA after exclusion of unknown location, were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. Outcome of Barthel Index at discharge was investigated and multivariate logistic regression analysis identified risk factors for morbidity of Barthel Index <90 at discharge in nonelderly and elderly patient groups. Results: Risk factors for morbidity at discharge were basilar artery aneurysm compared with internal carotid artery (ICA), diabetes mellitus (odds ratio [OR], 2.0–2.5; 95% confidence interval [CI], 1.6–3.7), antiplatelet drug, and anticoagulation drug; however, highest hospital volume compared with lowest was an inverse risk factor in both age groups. Endovascular coiling (OR, 0.4; 95% CI, 0.3–0.5) was a significantly inverse risk in the elderly group. Anterior communicating artery aneurysm compared with ICA was a significant risk (OR, 1.6; 95% CI, 1.0–2.6) in the nonelderly group; on the other hand, anterior communicating artery aneurysm (OR, 0.7; 95% CI, 0.5–0.95) and middle cerebral artery aneurysm (OR, 0.6; 95% CI, 0.5–0.8) compared with ICA were significantly inverse risks in the elderly group. Conclusions: Endovascular coiling after control of diabetes mellitus was recommended for the treatment of UCA in elderly patients. The ICA location of aneurysm in the elderly should be paid attention as the treatment risk.

AB - Background: This study aimed to clarify the risk factors of treatment for unruptured cerebral aneurysms (UCAs) in elderly patients by comparing the morbidity at discharge between surgical clipping and endovascular coiling in nonelderly (<65 years) and elderly (≥65 years) patients based on a national database in Japan. Methods: A total of 36,017, including 15,671 patients with UCA after exclusion of unknown location, were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. Outcome of Barthel Index at discharge was investigated and multivariate logistic regression analysis identified risk factors for morbidity of Barthel Index <90 at discharge in nonelderly and elderly patient groups. Results: Risk factors for morbidity at discharge were basilar artery aneurysm compared with internal carotid artery (ICA), diabetes mellitus (odds ratio [OR], 2.0–2.5; 95% confidence interval [CI], 1.6–3.7), antiplatelet drug, and anticoagulation drug; however, highest hospital volume compared with lowest was an inverse risk factor in both age groups. Endovascular coiling (OR, 0.4; 95% CI, 0.3–0.5) was a significantly inverse risk in the elderly group. Anterior communicating artery aneurysm compared with ICA was a significant risk (OR, 1.6; 95% CI, 1.0–2.6) in the nonelderly group; on the other hand, anterior communicating artery aneurysm (OR, 0.7; 95% CI, 0.5–0.95) and middle cerebral artery aneurysm (OR, 0.6; 95% CI, 0.5–0.8) compared with ICA were significantly inverse risks in the elderly group. Conclusions: Endovascular coiling after control of diabetes mellitus was recommended for the treatment of UCA in elderly patients. The ICA location of aneurysm in the elderly should be paid attention as the treatment risk.

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