[Variability in the management of aneurysmal subarachnoid haemorrhage in Spain: Analysis of the prospective multicenter database from the Working Group on Neurovascular Diseases of the Spanish Society of Neurosurgery]

Abstract

Introduction: In aneurysmal subarachnoid haemorrhage, endovascular or surgical exclusion of the aneurysm responsible for the bleeding is mandatory to prevent re-bleeding. In Spain there is no data regarding the frequency of usage of the two techniques, the moment treatment is performed, the existence of variability among the different centres treating these patients or the factors that determine the election of the therapeutic modality.

Objectives: 1) To describe the variability in the use of endovascular treatment or surgery in the treatment of these patients among the participating centres. 2) To establish which factors are related to the election of treatment and outcome.

Materials and methods: Of all the patients included in the database, we selected 2,150 cases suffering confirmed aneurysmal subarachnoid haemorrhage from 10 centres that included patients regularly during the period between 2004 and 2012 with a data completeness index over 95%. A descriptive analysis on mode of aneurysm treatment was performed. A multivariate analysis of the factors related to treatment modality of the aneurysm and outcome was performed using logistic regression.

Results: The ratio endovascular/surgical treatment was 1.32. There was high variability among centres regarding the frequency of endovascular treatment (32-80%). No treatment was given to 17% of the aneurysms, with this percentage being higher in the centres with lower rates of endovascular treatment. Lower volume centres treated aneurysms later. Age and poor clinical grade were factors related to the election of endovascular treatment, while middle cerebral artery location and unfavourable morphological criteria were factors of surgical treatment. The choice of treatment, guideline adherence and centre patient volume were not related to outcome.

Conclusions: There is high variability in the election of treatment modality among centres in Spain. Endovascular treatment allows more patients to have their aneurysm treated. Guideline adherence is moderate.

Keywords: Aneurisma cerebral; Cirugía; Clinical practice variation; Endovascular treatment; Hemorragia subaracnoidea; Intracranial aneurysm; Subarachnoid haemorrhage; Surgery; Therapeutics; Tratamiento; Tratamiento endovascular; Variabilidad en la práctica clínica.