Variations in Cerebral Aneurysm Treatments Raise Alarm

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Open versus catheter-based treatment for cerebral aneurysms varies widely across the United States, which suggests unwarranted practice variation, according to a report from the Dartmouth Atlas Project.

Researchers analyzed Medicare beneficiaries with cerebral aneurysms who underwent treatment from 2007 through 2012, adjusting for comorbidities and other factors.

The percentage of patients who received endovascular coiling for unruptured aneurysms ranged from a low of 35% in Modesto, Calif. to a high of 98.6% in Tacoma, Wash. For patients with ruptured aneurysms, percentages ranged from 36.3% in Atlanta to 98.8% in Fort Lauderdale, Florida. 

The national average came out to 71% of patients with unruptured aneurysms and 63% of patients with ruptured aneurysms receiving coiling versus clipping.

The amount of variation cannot just be attributed to patient choice, according to the researchers. They believe it could imply a systems problem in how patients participate in decisions as well as a variation in local resources and practices.

Population-based registries can help produce widely-applicable data to aid patients in decision making. The National Neurosurgery Quality and Outcomes Database recently launched a module that includes factors such as neurological status, durability of coiling, and the use of new endovascular devices to allow accurate risk-adjustment for comparison of coiling and clipping for aneurysms, the report noted.

Brain Aneurysm Tx: Too Much Practice Variation?
Variations in Cerebral Aneurysm Treatments Raise Alarm

The rate of open versus catheter-based treatment for cerebral aneurysms varies largely across the country, according to a report suggesting unwarranted practice variation. 

The rates of endovascular coiling for unruptured aneurysms among Medicare beneficiaries ranged from a low of 35% in Modesto, Calif. to a high of 98.6% in Tacoma, Wash., Kimon Bekelis, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, NH., and colleagues found.

While some variation in practice is expected, Bekelis called the level seen in the data "excessive."

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