| 【Aims】Discuss the clinical effects of the surgical clipping and the endovascular coiling for the treatment of aneurysmal subarachnoid hemorrhage,and conduct a health economic analysis of the two surgical methods,aiming to study the effect of patient diagnosis and treatment while reducing medical costs.It is planned to choose the better one Treatment programs.【 Method 】 This study used a retrospective cohort study.A collection of 223 patients with aneurysmal subarachnoid hemorrhage diagnosed in the Second Affiliated Hospital of the University of South China from January 2017 to October 2020 and eligible for inclusion were collected.They were surgically divided into craniotomy and clipping aneurysm group and Interventional surgery group.Use t test or Chi-square test to compare the treatment efficiency,mortality,complication,intraoperative blood loss,postoperative hospital stay,etc.between the two groups to evaluate the clinical effects of the two surgical methods.For the factors that may affect the clinical effect,a binary logistic regression analysis was performed to find independent risk factors that affect the prognosis.Compare the total cost,direct cost,indirect cost and the cost of each part of the two groups,used multiple linear regression analysis to explore the factors that may have a greater impact on the total cost range,and conduct a cost-effect analysis.Use SPSS22.0 for data analysis.【Result】1.The incidence of venous thrombosis in the lower extremities after the surgical clipping group was higher than that in the endovascular coiling group(P<0.05),and the remaining complications were not statistically significant(P>0.05).The postoperative mortality of the two types of surgery was not statistically significant(P>0.05).2.the endovascular coiling group had a slightly higher treatment efficiency than the surgical clipping group,but there was no significant statistical significance between the two(P>0.05).3.Multivariate logistic regression analysis showed that the preoperative Hunt-Hess classification was grade II-IV,and age and complications were related to the prognosis.The higher the grade,the worse the prognosis(OR=10.294,95%CI 2.5536-41.788,P=0.001;OR =7.263,95%CI1.888～27.942,P=0.003),the older the age,the more complications,the worse the prognosis(OR=0.915,95%CI 0.854 ～ 0.981,P=0.012;OR=1.375,95%CI 1.165～1.622,P=0).4.Compared with the surgical clipping group,the endovascular coiling group had less surgical blood loss,shorter operation time,and shorter postoperative hospital stay.The comparison between the two groups was statistically significant(P<0.05).5.Compared with the surgical clipping group,the blood transfusion cost,surgical treatment cost,intensive care cost,general ward cost,and indirect cost were lower in the endovascular coiling group,while the cost of consumables and the total hospitalization cost were higher.The comparison between the two groups was statistically significant(P<0.05).6.The two groups had statistically significant associations between age,hospitalization days,surgical methods,consumables costs,prognosis,and total cost(P<0.05),while gender,Hunt-Hess classification and total cost had little association(P>0.05).7.The cost-effectiveness ratio of the endovascular coiling group was186121.007 yuan,and the cost-effectiveness ratio of the surgical clipping group was 126592.721 yuan,which was slightly higher than that of the surgical clipping group.【Conclusion】1.The surgical clipping group has less trauma,quick recovery,fewer complications,and the overall effect was better than the endovascular coiling group.2.Preoperative Hunt-Hess classification,age and postoperative complications may be independent factors that affect the treatment effect.3.The cost-effectiveness ratio of the endovascular coiling group was slightly higher than that of the surgical clipping group.Appropriately reducing the cost of interventional consumables can benefit patients more. |
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