• Jian-Han Chen, Chih-Yuan Huang, Yi-Che Lee, Kuo-Wei Wang, Po-Chou Liliang, Cheng-Loong Liang, Kang Lu, Han-Jung Chen, Yuan-Ting Sun, and Hao-Kuang Wang.
• Department of General Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
• World Neurosurg. 2018 Aug 1; 116: e485-e490.

ObjectiveUsing a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling.MethodsThis study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined.ResultsA total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P < 0.001) and significantly higher total hospital costs (P < 0.001).ConclusionsIn Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.Copyright © 2018 Elsevier Inc. All rights reserved.

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