Impact of clinical trials on neurosurgical practice: An assessment of case volume

Scott Simon, Tatsuki Koyama, Brad Zacharia, Clemens M. Schirmer, Joseph S. Cheng

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: To evaluate the effect of important trials on the practice of neurosurgery. - METHODS: We hypothesized that evidence from trials addressing the management of intracranial aneurysms (International Subarachnoid Aneurysm Trial [ISAT]) and nontraumatic intracerebral hemorrhages (Surgical Trial in Intracerebral Hemorrhage [STICH]) and vertebral augmentation for osteoporotic vertebral body fractures had a significant impact on the frequency of the corresponding neurosurgical procedures. A Medicare administrative database was queried for corresponding Common Procedural Terminology codes and units billed per calendar year. The effects of ISAT and STICH were evaluated using a generalized linear model. The effect of the vertebral augmentation study was evaluated using a t test. - RESULTS: After publication of ISAT in 2002, the rate of increase in proportion of cerebral aneurysms that were treated with embolization (Common Procedural Terminology code 61624) per year increased from 3.9% to 5.5% (P[0.01). After publication of STICH in 2005, the number of craniotomies performed for intracerebral hematoma decreased from 2341 in 2002 to 1646 in 2011 (P [ 0.03). After 2 publications in 2009, performance of vertebral augmentation decreased from a high of 99,961 in 2009 per year to 77,108 in 2013 (P [ 0.002). - CONCLUSIONS: Randomized clinical trials remain the gold standard in the medical community to demonstrate efficacy, but their true impact relies on rapid and extensive assimilation into everyday medical practice. However, the described methodology establishes a temporal relationship only and does not prove causation. Nonetheless, trends in procedural volume suggest that the results of these select randomized clinical trials had a significant effect on neurosurgical practice affecting Medicare patients within an interval of a few years.

Original languageEnglish (US)
Pages (from-to)431-437
Number of pages7
JournalWorld Neurosurgery
Volume83
Issue number4
DOIs
StatePublished - Jan 1 2015

Fingerprint

Cerebral Hemorrhage
Clinical Trials
Aneurysm
Publications
Intracranial Aneurysm
Medicare
Terminology
Randomized Controlled Trials
Neurosurgical Procedures
Craniotomy
Neurosurgery
Causality
Hematoma
Linear Models
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Simon, Scott ; Koyama, Tatsuki ; Zacharia, Brad ; Schirmer, Clemens M. ; Cheng, Joseph S. / Impact of clinical trials on neurosurgical practice : An assessment of case volume. In: World Neurosurgery. 2015 ; Vol. 83, No. 4. pp. 431-437.
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Impact of clinical trials on neurosurgical practice : An assessment of case volume. / Simon, Scott; Koyama, Tatsuki; Zacharia, Brad; Schirmer, Clemens M.; Cheng, Joseph S.

In: World Neurosurgery, Vol. 83, No. 4, 01.01.2015, p. 431-437.

Research output: Contribution to journalArticle

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