Coiling vs. Clipping: Hospital Stay and Procedure Time in Intracranial Aneurysm Treatment.

PURPOSE: Evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. MATERIALS AND METHODS: Retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. RESULTS: Clinical admission grade (rupt. A: Hunt and Hess grade 1 - 3: clip: 73 % coil: 72 %) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1 / 13.8 % coil: 45.5 / 10.3 % non-rupt. A: 88.2 / 0 % coil: 88.5 / 1.3 %) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p <0.01; non-rupt. A: coil: 164 min, clip: 200 min; p <0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6 d, p <0.01; non-rupt. A: coil: 1.5 d; clip: 2 d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4 d; clip: 26.8 d, p <0.01; non-rupt. A: coil: 9.2 d; clip: 17.5 d; p = 0.01).The discharge to home ratio did not differ (rupt. A: clip: 31.6 % coil: 29.7 % non-rupt. A: clip: 74.5 % coil: 80.5 %). CONCLUSION: In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.