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Bueso Navarro M, Zabalegui Pérez A, Blandino Ortiz A, Vidal Tegedor B, Galarza Barrachina L. Current situation and characteristics of centers specialized in management of aneurysmal subarachnoid hemorrhage in Spain. Med Intensiva 2024; 48:426-428. [PMID: 38584012 DOI: 10.1016/j.medine.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Marta Bueso Navarro
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | | | - Aaron Blandino Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Bárbara Vidal Tegedor
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - Laura Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain.
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Bock LA, Noben CY, van Mook WN, de Ridder IR, van Zwam WH, Schenck HE, Haeren RH, Essers BA. Endovascular treatment and neurosurgical clipping in subarachnoid hemorrhage: a systematic review of economic evaluations. J Neurosurg Sci 2023; 67:18-25. [PMID: 35147403 DOI: 10.23736/s0390-5616.21.05503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There are two treatment modalities for aneurysmal subarachnoid hemorrhage: endovascular treatment (EVT) and neurosurgical clipping. Results of economic evaluations are needed to gain insight into the relationship between clinical effectiveness and costs of these treatment modalities. This important information can inform both clinical decision-making processes and policymakers in facilitating Value-Based Healthcare. EVIDENCE ACQUISITION Databases (PubMed, Embase, Cochrane Library, the Centre for Reviews and Dissemination, EBSCO, and Web of Science) were searched for studies published until October 2020 that had performed economic evaluations in aneurysmal subarachnoid hemorrhage patients by comparing EVT with neurosurgical clipping. The quality of reporting and methodology of these evaluations was assessed using the associated instruments (i.e. CHEERS statement and CHEC-list, respectively). EVIDENCE SYNTHESIS A total of 6 studies met the inclusion criteria. All included studies reported both effects and costs, however five did not relate effects to costs. Only one study related effects directly to costs, thus conducted a full economic evaluation. The reporting quality scored 81% and the methodological quality scored 30%. CONCLUSIONS The quality of published cost-effectiveness studies on the treatment of aneurysmal subarachnoid hemorrhage is poor. Six studies reported both outcomes and costs, however only one study performed a full economic evaluation comparing EVT to neurosurgical clipping. Although the reporting quality was sufficient, the methodological quality was poor. Further research that relates health-related quality of life measures to costs of EVT and neurosurgical clipping is required - specifically focusing on both reporting and methodological quality. Different subgroup analyses and modeling could also enhance the findings.
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Affiliation(s)
- Lotte A Bock
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands - .,School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands -
| | - Cindy Y Noben
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walther N van Mook
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands.,School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands.,Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inger R de Ridder
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hanna E Schenck
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roel H Haeren
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Brigitte A Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
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Llompart-Pou J, Barea-Mendoza J, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz M, Chico-Fernández M. Encuesta de atención al paciente neurocrítico en España. Parte 2: Patología cerebrovascular. Med Intensiva 2021. [DOI: 10.1016/j.medin.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MÁ, Chico-Fernández M. Survey of neurocritical patient care in Spain. Part 2: Cerebrovascular disease. Med Intensiva 2021; 45:e1-e3. [PMID: 34217639 DOI: 10.1016/j.medine.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain.
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
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Neira N, Leiva N, Vílchez-Oya F, Salas LA, Boza R, Guillén-Solà A, Duarte E. [Long-term cognitive and functional status in survivors of an aneurysmal subarachnoid hemorrhage: Analysis of a retrospective cohort]. Rehabilitacion (Madr) 2021; 56:93-98. [PMID: 33858669 DOI: 10.1016/j.rh.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Little data is available on long-term functional and cognitive outcomes in patients with aneurysmal subarachnoid hemorrhage (ASH). The main objective of this study was to assess cognition, functional state, mood disorders, and quality of life in patients with SAH at least six months following the ASH. PATIENTS AND METHODS Cross-sectional study of 40 patients (aged 58.2 [SD 9.9] years) with ASH, discharged from a Neurologic Rehabilitation unit between January 2010 and July 2017. MAIN OUTCOME VARIABLES functional status (Barthel index), cognition (Pfeiffer questionnaire), depression (Hamilton scale), and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), as well as type and duration of therapeutic rehabilitation procedures after discharge. RESULTS From 35 patients with cognitive disorders, only 12 received cognitive therapy at hospital discharge. In the long-term follow-up, cognitive impairment persisted in 22 patients. When compared with those without cognitive impairment, they presented significantly worse mean differences in the Barthel index (15.5 [95% CI: 1.2-29.7]), Hamilton scale (-0.8 [95% CI: -1.27 to -0.37]), and EQ-5D (27.6 [95% CI: 12.4-19]). CONCLUSION The prevalence of long-term cognitive impairments in survivors of a SAH episode is high, and their presence is associated with worse functional status, more depression and worse quality of life. The low percentage of subjects who received cognitive therapies through their recovery process and the clinical implications observed, support the need of including neuropsychological therapies in the rehabilitation programs after an SAH event.
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Affiliation(s)
- N Neira
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España
| | - N Leiva
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España; Servicio de Geriatría, Parc de Salut Mar, Barcelona, España
| | - F Vílchez-Oya
- Servicio de Reumatología, Parc de Salut Mar, Barcelona, España
| | - L A Salas
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España
| | - R Boza
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España; Grup de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España
| | - A Guillén-Solà
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España; Grup de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Facultad de Medicina, Universistat Autònoma de Barcelona, Barcelona, España
| | - E Duarte
- Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar, Barcelona, España; Grup de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Facultad de Medicina, Universistat Autònoma de Barcelona, Barcelona, España.
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Vilalta J. Trends in the treatment of cerebral aneurysms: Analysis of a hospital series. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Arikan F, Errando N, Lagares A, Gándara D, Gabarros A, López-Ojeda P, Ibáñez J, Brell M, Gómez PA, Fernández-Alén JA, Morera J, Horcajadas A, Vanaclocha V, Llácer JL, Baño-Ruiz E, Gonçalves-Estella JM, Torné R, Hoyos JA, Sarabia R, Arrese I, Rodríguez-Boto G, de la Lama A, Domínguez J, Martín-Láez R, Santamarta-Gómez D, Delgado-López PD, Ley-Urzaiz L, Mateo O, Iza B, Orduna-Martínez J, de Asís Lorente-Muñoz F, Muñoz-Hernández F, Iglesias J, Vilalta J. Variability of Clinical and Angiographic Results Based on the Treatment Preference (Endovascular or Surgical) of Centers Participating in the Subarachnoid Hemorrhage Database of the Working Group of the Spanish Society of Neurosurgery. World Neurosurg 2019; 135:e339-e349. [PMID: 31811967 DOI: 10.1016/j.wneu.2019.11.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Since the introduction of endovascular treatment for cerebral aneurysms, hospitals in which subarachnoid hemorrhage is treated show different availability and/or preferences towards both treatment modalities. The main aim is to evaluate the clinical and angiographic results according to the hospital's treatment preferences applied. METHODS This study was conducted based on use of the subarachnoid hemorrhage database of the Vascular Pathology Group of the Spanish Neurosurgery Society. Centers were classified into 3 subtypes according to an index in the relationship between endovascular and surgical treatment as: endovascular preference, high endovascular preference, and elevated surgical preference. The clinical results and angiographic results were evaluated among the 3 treatment strategies. RESULTS From November 2004 to December 2017, 4282 subarachnoid hemorrhage patients were selected for the study: 630 (14.7%) patients from centers with surgical preference, 2766 (64.6%) from centers with endovascular preference, and 886 (20.7%) from centers with high endovascular preference. The surgical preference group obtained the best angiographic results associated with a greater complete exclusion (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). The surgical preference subgroup obtained the best outcome at discharge (65.45%), followed by the high endovascular preference group (61.5%) and the endovascular preference group (57.8%) (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). CONCLUSIONS In Spain, there is significant variability in aneurysm exclusion treatment in aneurysmal subarachnoid hemorrhage. Surgical centers offer better results for both surgical and endovascular patients. A multidisciplinary approach and the maintenance of an elevated quality of surgical competence could be responsible for these results.
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Affiliation(s)
- Fuat Arikan
- Neurosurgery Department, University Hospital Vall d'Hebron, Barcelona, Spain; Neurotraumatology-Neurosurgery Research Unit (UNINN), Research Institute Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Alfonso Lagares
- Neurosurgery Department, Hospital 12 de Octubre, Imas12, Universidad Complutense de Madrid, Spain
| | - Darío Gándara
- Neurosurgery Department, University Hospital Vall d'Hebron, Barcelona, Spain; Neurotraumatology-Neurosurgery Research Unit (UNINN), Research Institute Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreu Gabarros
- Neurosurgery Department, University Hospital of Bellvitge and University of Barcelona, Barcelona, Spain
| | - Pablo López-Ojeda
- Neurosurgery Department, University Hospital of Bellvitge and University of Barcelona, Barcelona, Spain
| | - Javier Ibáñez
- Neurosurgery Department, University Hospital of Son Espases, Palma de Mallorca, Spain
| | - Marta Brell
- Neurosurgery Department, University Hospital of Son Espases, Palma de Mallorca, Spain
| | - Pedro A Gómez
- Neurosurgery Department, Hospital 12 de Octubre, Imas12, Universidad Complutense de Madrid, Spain
| | - Jose A Fernández-Alén
- Neurosurgery Department, Hospital 12 de Octubre, Imas12, Universidad Complutense de Madrid, Spain
| | - Jesús Morera
- Neurosurgery Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Angel Horcajadas
- Neurosurgery Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Vicente Vanaclocha
- Neurosurgery Department, General University Hospital Consortium of Valencia, Spain
| | - José L Llácer
- Neurosurgery Department, Hospital Ribera, Alzira, Spain
| | - Elena Baño-Ruiz
- Neurosurgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Ramon Torné
- Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Augusti Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Jhon A Hoyos
- Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Rosario Sarabia
- Neurovascular Unit UNVRH, Neurosurgery Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Ignacio Arrese
- Neurovascular Unit UNVRH, Neurosurgery Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Gregorio Rodríguez-Boto
- Neurosurgery Department, University Hospital Clínico San Carlos, Complutense University, Madrid, Spain; Neurosurgery Department, University Hospital Puerta de Hierro-Majadahonda, Autonomous University, Madrid, Spain
| | | | - Jaime Domínguez
- Neurosurgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Rubén Martín-Láez
- Department of Neurosurgery and Surgical Spine Unit, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | - Luís Ley-Urzaiz
- Neurosurgery Department, University Hospital Ramon y Cajal, Madrid, Spain
| | - Olga Mateo
- Neurosurgery Department, University Hospital Gregorio Marañon, Madrid, Spain
| | - Begoña Iza
- Neurosurgery Department, University Hospital Gregorio Marañon, Madrid, Spain
| | | | | | | | - Jone Iglesias
- Neurosurgery Department, University Hospital of Cruces, Barakaldo, Spain
| | - Jordi Vilalta
- Neurosurgery Department, University Hospital Vall d'Hebron, Barcelona, Spain; Neurotraumatology-Neurosurgery Research Unit (UNINN), Research Institute Vall d'Hebron, Barcelona, Spain
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Trends in the treatment of cerebral aneurysms: Analysis of a hospital series. Neurologia 2017; 35:128-130. [PMID: 29248208 DOI: 10.1016/j.nrl.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022] Open
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Delgado Lopez PD, Castilla Díez JM, Martín Velasco V. Aneurismas cerebrales no rotos: controversias sobre el cribado poblacional. Neurocirugia (Astur) 2016; 27:237-44. [DOI: 10.1016/j.neucir.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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Delgado-López PD, López-Martínez JL, Gero-Escapa M, Martín-Alonso J, Castaño-Blazquez M, Ossa-Echeverri S, Martín-Velasco V, Castilla-Díez JM. [Aneurysmal subarachnoid haemorrhage: Results after introducing endovascular therapy in a medium-low volume centre]. Neurocirugia (Astur) 2016; 27:207-19. [PMID: 26975879 DOI: 10.1016/j.neucir.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre. MATERIAL AND METHODS A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS). RESULTS Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P=.35), GOS (except for GOS 5: 43.37% vs 53.8%, P=.045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P=.034) and for GOS 4+5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P<.01), as well as the rate of re-bleeding (0% vs 9.4%, P<.01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance. CONCLUSIONS Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality.
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Affiliation(s)
| | - José Luis López-Martínez
- Servicio de Radiología, Sección de Neurorradiología Intervencionista, Hospital Universitario de Burgos, Burgos, España
| | - María Gero-Escapa
- Servicio de Cuidados Intensivos, Hospital Universitario de Burgos, Burgos, España
| | | | - Miguel Castaño-Blazquez
- Servicio de Radiología, Sección de Neurorradiología Intervencionista, Hospital Universitario de Burgos, Burgos, España
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