AI Article Synopsis
- Benchmarks for surgical outcomes of unruptured intracranial aneurysms (UIA) are lacking globally, prompting this study to establish standardized outcome metrics based on a large analysis of 2,245 microsurgical cases across multiple centers.
- The research classified patients into low-risk ("benchmark") and high-risk ("nonbenchmark") groups using established factors, defining benchmark outcomes such as surgery duration, complications, and recovery metrics based on percentages from the patient data.
- The findings resulted in various benchmark cutoffs, revealing significant patient outcome improvements in the benchmark group, including higher rates of favorable neurological outcomes and lower complication rates compared to the nonbenchmark group at follow-up.
Article Abstract
Background And Objectives: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA.
Methods: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately.
Results: Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients.
Conclusion: This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA. These benchmark cutoffs can serve as reference values for other centers, patient registries, and for comparing the benefit of other interventions or novel surgical techniques.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10766286 | PMC |
| http://dx.doi.org/10.1227/neu.0000000000002689 | DOI Listing |
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