目的:分流依赖性脑积水是动脉瘤性蛛网膜下腔出血(SAH)的主要并发症。尽管如此,影响分流依赖性和分流失败的因素尚不清楚.因此,本研究的目的是使用韩国国家健康保险数据库,在13年的时间内,估计分流依赖性和故障率,并确定动脉瘤性SAH患者的影响因素.
方法:纳入年龄>18岁接受外科手术的动脉瘤性SAH患者。使用分流手术处方数据,根据性别评估分流依赖性脑积水率,年龄,动脉瘤位置,和入学年份。在接受分流手术的患者中,分流失败率是使用手术处方数据估算的.
结果:共纳入57,030例接受动脉瘤手术的SAH患者。分流依赖性脑积水的总体原始率为15.0%(8530/57,030)。年龄(HR1.04,95%CI1.04-1.04;p<0.001)和血管内卷绕(与手术夹,HR0.71,95%CI0.67-0.74;p<0.001)在多变量逻辑回归分析中与分流依赖性脑积水相关。后循环和前交通动脉瘤显示出分流依赖性的高风险。在8530名接受分流手术的患者中,分流故障率为11.3%(961/8530)。女性(HR1.18,95%CI1.01-1.39;p=0.0324),年龄(HR0.99,95%CI0.98-0.99;p<0.001),在多因素logistic回归分析中,早期分流安置(HR1.25,95%CI1.08~1.47;p=0.004)和腰腹腔分流安置(HR2.19,95%CI1.65~2.91;p<0.001)是分流失败的危险因素.
结论:在本研究中,使用韩国的医疗索赔数据库,动脉瘤性SAH后分流依赖性脑积水的发生率为15.0%。60岁和70岁患者的分流手术率最高。11.3%的患者发生分流失败,腰腹腔分流术与翻修手术的需要最为相关.
OBJECTIVE: Shunt-dependent hydrocephalus is a major complication of aneurysmal subarachnoid hemorrhage (SAH). Despite this, the factors influencing shunt dependency and shunt failure remain unclear. Therefore, the aim of this study was to estimate shunt dependency and failure rates and determine the contributing factors in patients with aneurysmal SAH using the Korean National Health Insurance database over a 13-year period.
METHODS: Patients with aneurysmal SAH aged > 18 years who underwent surgical procedures were included. Using the shunt surgery prescription data, the shunt-dependent hydrocephalus rate was evaluated according to sex, age, aneurysm location, and year of admission. Among patients who underwent shunt surgery, the shunt failure rate was estimated using surgical prescription data.
RESULTS: A total of 57,030 patients with SAH who underwent aneurysm surgery were included. The overall raw rate of shunt-dependent hydrocephalus was 15.0% (8530/57,030). Age (HR 1.04, 95% CI 1.04-1.04; p < 0.001) and endovascular coiling (vs surgical clipping, HR 0.71, 95% CI 0.67-0.74; p < 0.001) were related to shunt-dependent hydrocephalus in the multivariate logistic regression analysis. Posterior circulation and anterior communicating aneurysms showed a high risk of shunt dependency. Among 8530 patients who underwent shunt surgery, the shunt failure rate was 11.3% (961/8530). Female sex (HR 1.18, 95% CI 1.01-1.39; p = 0.0324), age (HR 0.99, 95% CI 0.98-0.99; p < 0.001), early shunt placement (HR 1.25, 95% CI 1.08-1.47; p = 0.004) and lumboperitoneal shunt placement (HR 2.19, 95% CI 1.65-2.91; p < 0.001) were the risk factors for shunt failure in the multivariate logistic regression analysis.
CONCLUSIONS: The rate of shunt-dependent hydrocephalus after aneurysmal SAH was 15.0% in this study using a medical claims database in Korea. The shunt surgery rate was highest in patients in their 60s and 70s. Shunt failure occurred in 11.3% of the patients, and a lumboperitoneal shunt was most related to the need for revision surgery.