Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Outcomes of Coil Embolization for Unruptured Intracranial Aneurysms Categorized by Region and Hospital Size : A Nationwide Cohort Study in Korea

  • Bong-Gyu Ryu (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Si Un Lee (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hwan Seok Shim (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jeong-Mee Park (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Yong Jae Lee (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Young-Deok Kim (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Tackeun Kim (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Seung Pil Ban (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hyoung Soo Byoun (Department of Neurosurgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Jae Seung Bang (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • O-Ki Kwon (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chang Wan Oh (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2023.02.14
  • Accepted : 2023.08.22
  • Published : 2023.11.01
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Abstract

Objective : To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. Methods : The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. Results : In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. Conclusion : The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians' experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

Keywords

Acknowledgement

This study was supported by the Research Funds of the Korean Neuroendovascular Society.

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