{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:26:03Z","timestamp":1794014763148,"version":"4.8.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006\u20132017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (\u03b2 = 0.6 and p = 0.009 for mFI-5; \u03b2 = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p &lt; 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p &lt; 0.001 for mFI-5; c-statistic = 0.610 and p &lt; 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.2.jns204420","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T13:54:02Z","timestamp":1629467642000},"page":"456-463","source":"Crossref","is-referenced-by-count":13,"title":["Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms"],"prefix":"10.3171","volume":"136","author":[{"given":"James","family":"Feghali","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Gami","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Rapaport","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimin","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham M.","family":"Khalafallah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakibul","family":"Huq","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debraj","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael J.","family":"Tamargo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10206","key":"r1","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1016\/S0140-6736(19)31785-4","article-title":"Management of frailty: opportunities, challenges, and future directions","volume":"394","author":"Dent E","year":"2019","unstructured":"Dent E, Martin FC, Bergman H,  Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376\u20131386.3160922910.1016\/S0140-6736(19)31785-4"},{"issue":"6","key":"r2","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/j.jamcollsurg.2010.01.028","article-title":"Frailty as a predictor of surgical outcomes in older patients","volume":"210","author":"Makary MA","year":"2010","unstructured":"Makary MA, Segev DL, Pronovost PJ,  Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901\u2013908.2051079810.1016\/j.jamcollsurg.2010.01.028"},{"issue":"5","key":"r3","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.amjsurg.2011.06.017","article-title":"Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults","volume":"202","author":"Robinson TN","year":"2011","unstructured":"Robinson TN, Wu DS, Stiegmann GV, Moss M. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg. 2011;202(5):511\u2013514.10.1016\/j.amjsurg.2011.06.01721890098"},{"issue":"5","key":"r4","series-title":"J Chronic Dis","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u2013383.355871610.1016\/0021-9681(87)90171-8"},{"issue":"1","key":"r5","series-title":"J Surg Res","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.jss.2013.01.021","article-title":"Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database","volume":"183","author":"Velanovich V","year":"2013","unstructured":"Velanovich V, Antoine H, Swartz A,  Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183(1):104\u2013110.2341549410.1016\/j.jss.2013.01.021"},{"issue":"2","key":"r6","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1001\/jamasurg.2016.3479","article-title":"Use of the modified frailty index in the American College of Surgeons National Surgical Improvement Program database: highlighting the problem of missing data","volume":"152","author":"Gani F","year":"2017","unstructured":"Gani F, Canner JK, Pawlik TM. Use of the modified frailty index in the American College of Surgeons National Surgical Improvement Program database: highlighting the problem of missing data. JAMA Surg. 2017;152(2):205\u2013207.10.1001\/jamasurg.2016.347927784060"},{"issue":"2","key":"r7","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-factor modified frailty index using American College of Surgeons NSQIP Data","volume":"226","author":"Subramaniam S","year":"2018","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-factor modified frailty index using American College of Surgeons NSQIP Data. J Am Coll Surg. 2018;226(2):173\u2013181.e8.10.1016\/j.jamcollsurg.2017.11.00529155268"},{"issue":"7","key":"r8","series-title":"J Arthroplasty","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1016\/j.arth.2019.02.060","article-title":"Frailty predicts medical complications, length of stay, readmission, and mortality in revision hip and knee arthroplasty","volume":"34","author":"Traven SA","year":"2019","unstructured":"Traven SA, Reeves RA, Slone HS, Walton ZJ. Frailty predicts medical complications, length of stay, readmission, and mortality in revision hip and knee arthroplasty. J Arthroplasty. 2019;34(7):1412\u20131416.10.1016\/j.arth.2019.02.06030930155"},{"issue":"10","key":"r9","series-title":"J Shoulder Elbow Surg","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1016\/j.jse.2019.03.009","article-title":"Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty","volume":"28","author":"Traven SA","year":"2019","unstructured":"Traven SA, McGurk KM, Reeves RA,  Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28(10):1854\u20131860.10.1016\/j.jse.2019.03.00931202629"},{"issue":"7","key":"r10","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/BOT.0000000000001455","article-title":"New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures","volume":"33","author":"Traven SA","year":"2019","unstructured":"Traven SA, Reeves RA, Althoff AD,  New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures. J Orthop Trauma. 2019;33(7):319\u2013323.10.1097\/BOT.000000000000145530730361"},{"issue":"4","key":"r11","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.3171\/2020.7.FOCUS20324","article-title":"Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors","volume":"49","author":"Theriault BC","year":"2020","unstructured":"Theriault BC, Pazniokas J, Adkoli AS,  Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors. Neurosurg Focus. 2020;49(4):E16.10.3171\/2020.7.FOCUS2032433002880"},{"issue":"4","key":"r12","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E15","DOI":"10.3171\/2020.7.FOCUS20426","article-title":"The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms","volume":"49","author":"Shahrestani S","year":"2020","unstructured":"Shahrestani S, Lehrich BM, Tafreshi AR,  The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms. Neurosurg Focus. 2020;49(4):E15.3300286510.3171\/2020.7.FOCUS20426"},{"issue":"3","key":"r13","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s11060-020-03626-1","article-title":"A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors","volume":"149","author":"Khalafallah AM","year":"2020","unstructured":"Khalafallah AM, Jimenez AE, Patel P,  A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors. J Neurooncol. 2020;149(3):429\u2013436.3296435410.1007\/s11060-020-03626-1"},{"issue":"1","key":"r14","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3171\/2020.5.JNS20766","article-title":"The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients","volume":"135","author":"Khalafallah AM","year":"2021","unstructured":"Khalafallah AM, Huq S, Jimenez AE,  The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients. J Neurosurg. 2021;135(1):78\u201386.10.3171\/2020.5.JNS20766"},{"issue":"4","key":"r15","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/2020.7.FOCUS20482","article-title":"Impact of frailty on surgery for glioblastoma: a critical evaluation of patient outcomes and caregivers\u2019 perceptions in a developing country","volume":"49","author":"Katiyar V","year":"2020","unstructured":"Katiyar V, Sharma R, Tandon V,  Impact of frailty on surgery for glioblastoma: a critical evaluation of patient outcomes and caregivers\u2019 perceptions in a developing country. Neurosurg Focus. 2020;49(4):E14.10.3171\/2020.7.FOCUS20482"},{"issue":"1","key":"r16","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1093\/neuros\/nyaa335","article-title":"Predicting postoperative outcomes in brain tumor patients with a 5-factor modified frailty index","volume":"88","author":"Huq S","year":"2020","unstructured":"Huq S, Khalafallah AM, Jimenez AE,  Predicting postoperative outcomes in brain tumor patients with a 5-factor modified frailty index. Neurosurgery. 2020;88(1):147\u2013154.10.1093\/neuros\/nyaa33532803222"},{"issue":"3","key":"r17","series-title":"Anesthesiol J Am Soc Anesthesiol","first-page":"281","article-title":"Grading of patients for surgical procedures","volume":"2","author":"Saklad MDM","year":"1941","unstructured":"Saklad MDM. Grading of patients for surgical procedures. Anesthesiol J Am Soc Anesthesiol. 1941;2(3):281\u2013284."},{"issue":"3","key":"r18","series-title":"JAMA Neurol","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1001\/jamaneurol.2018.4165","article-title":"Procedural clinical complications, case-fatality risks, and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis","volume":"76","author":"Algra AM","year":"2019","unstructured":"Algra AM, Lindgren A, Vergouwen MDI,  Procedural clinical complications, case-fatality risks, and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis. JAMA Neurol. 2019;76(3):282\u2013293.3059248210.1001\/jamaneurol.2018.4165"},{"issue":"6","key":"r19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1097\/00006123-200112000-00008","article-title":"Remote cerebellar hemorrhage after supratentorial surgery","volume":"49","author":"Friedman JA","year":"2001","unstructured":"Friedman JA, Piepgras DG, Duke DA,  Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery. 2001;49(6):1327\u20131340.10.1097\/00006123-200112000-0000811846932"},{"issue":"3","key":"r20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"417","DOI":"10.3171\/jns.2001.94.3.0417","article-title":"Functional outcome after repair of unruptured intracranial aneurysms","volume":"94","author":"Chyatte D","year":"2001","unstructured":"Chyatte D, Porterfield R. Functional outcome after repair of unruptured intracranial aneurysms. J Neurosurg. 2001;94(3):417\u2013421.1123594510.3171\/jns.2001.94.3.0417"},{"issue":"4","key":"r21","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.3171\/2018.12.JNS182873","article-title":"Adverse events after clipping of unruptured intracranial aneurysms: the NSQIP unruptured aneurysm scale","volume":"132","author":"Dasenbrock HH","year":"2020","unstructured":"Dasenbrock HH, Rudy RF, Smith TR,  Adverse events after clipping of unruptured intracranial aneurysms: the NSQIP unruptured aneurysm scale. J Neurosurg. 2020;132(4):1123\u20131132.10.3171\/2018.12.JNS182873"},{"issue":"7","key":"r22","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1161\/STROKEAHA.110.580647","article-title":"Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm","volume":"41","author":"Alshekhlee A","year":"2010","unstructured":"Alshekhlee A, Mehta S, Edgell RC,  Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke. 2010;41(7):1471\u20131476.10.1161\/STROKEAHA.110.580647"},{"issue":"1","key":"r23","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1002\/1531-8249(200007)48:1<11::AID-ANA4>3.0.CO;2-V","article-title":"Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks","volume":"48","author":"Johnston SC","year":"2000","unstructured":"Johnston SC, Wilson CB, Halbach VV,  Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol. 2000;48(1):11\u201319.10.1002\/1531-8249(200007)48:1<11::AID-ANA4>3.0.CO;2-V10894211"},{"issue":"1","key":"r24","series-title":"Epidemiology","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/01.ede.0000147512.81966.ba","article-title":"Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples","volume":"16","author":"Schisterman EF","year":"2005","unstructured":"Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology. 2005;16(1):73\u201381.1561394810.1097\/01.ede.0000147512.81966.ba"},{"key":"r25","series-title":"Comput Math Methods Med","doi-asserted-by":"publisher","first-page":"3762651","DOI":"10.1155\/2017\/3762651","article-title":"Defining an optimal cut-point value in ROC analysis: an alternative approach","volume":"2017","author":"Unal I","year":"2017","unstructured":"Unal I. Defining an optimal cut-point value in ROC analysis: an alternative approach. Comput Math Methods Med. 2017;2017:3762651.2864280410.1155\/2017\/3762651"},{"issue":"3","key":"r26","series-title":"Biometrics","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong ER","year":"1988","unstructured":"DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837\u2013845.10.2307\/2531595"},{"key":"r27","series-title":"Infect Dis Model","first-page":"111","article-title":"A primer on model selection using the Akaike Information Criterion","volume":"5","author":"Portet S","year":"2020","unstructured":"Portet S. A primer on model selection using the Akaike Information Criterion. Infect Dis Model. 2020;5:111\u2013128.31956740"},{"issue":"3","key":"r28","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"760","DOI":"10.3171\/2015.2.JNS142721","article-title":"Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program","volume":"124","author":"Lukasiewicz AM","year":"2016","unstructured":"Lukasiewicz AM, Grant RA, Basques BA,  Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg. 2016;124(3):760\u2013766.10.3171\/2015.2.JNS14272126315000"},{"issue":"4","key":"r29","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1161\/STROKEAHA.115.012097","article-title":"Risk score for neurological complications after endovascular treatment of unruptured intracranial aneurysms","volume":"47","author":"Ji W","year":"2016","unstructured":"Ji W, Liu A, Lv X,  Risk score for neurological complications after endovascular treatment of unruptured intracranial aneurysms. Stroke. 2016;47(4):971\u2013978.10.1161\/STROKEAHA.115.01209726869386"},{"issue":"3","key":"r30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"713","DOI":"10.3171\/2015.8.JNS14553","article-title":"A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms","volume":"125","author":"Newman WC","year":"2016","unstructured":"Newman WC, Neal DW, Hoh BL. A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms. J Neurosurg. 2016;125(3):713\u2013719.10.3171\/2015.8.JNS1455326745486"},{"issue":"3","key":"r31","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"452","DOI":"10.3171\/jns.2003.99.3.0452","article-title":"Intraoperative factors associated with surgical outcome in patients with unruptured cerebral aneurysms: the experience of a single surgeon","volume":"99","author":"Grigorian AA","year":"2003","unstructured":"Grigorian AA, Marcovici A, Flamm ES. Intraoperative factors associated with surgical outcome in patients with unruptured cerebral aneurysms: the experience of a single surgeon. J Neurosurg. 2003;99(3):452\u2013457.1295942910.3171\/jns.2003.99.3.0452"},{"issue":"6","key":"r32","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1007\/s11102-020-01069-5","article-title":"The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas","volume":"23","author":"Khalafallah AM","year":"2020","unstructured":"Khalafallah AM, Shah PP, Huq S,  The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas. Pituitary. 2020;23(6):630\u2013640.10.1007\/s11102-020-01069-532725418"},{"issue":"5","key":"r33","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.3171\/2018.1.JNS171552","article-title":"Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial","volume":"130","author":"Wang Y","year":"2019","unstructured":"Wang Y, Liu B, Zhao T,  Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial. J Neurosurg. 2019;130(5):1680\u20131691.10.3171\/2018.1.JNS171552"},{"issue":"11","key":"r34","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.3174\/ajnr.A3566","article-title":"Are routine intensive care admissions needed after endovascular treatment of unruptured aneurysms?","volume":"34","author":"Burrows AM","year":"2013","unstructured":"Burrows AM, Rabinstein AA, Cloft HJ,  Are routine intensive care admissions needed after endovascular treatment of unruptured aneurysms? AJNR Am J Neuroradiol. 2013;34(11):2199\u20132201.2374469510.3174\/ajnr.A3566"},{"issue":"1","key":"r35","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3174\/ajnr.A2739","article-title":"Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the United States are substantially higher than Medicare payments","volume":"33","author":"Brinjikji W","year":"2012","unstructured":"Brinjikji W, Kallmes DF, Lanzino G, Cloft HJ. Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the United States are substantially higher than Medicare payments. AJNR Am J Neuroradiol. 2012;33(1):49\u201351.10.3174\/ajnr.A273922033718"},{"issue":"2","key":"r36","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1161\/STROKEAHA.109.569269","article-title":"Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the Nationwide Inpatient Sample database 2002 to 2006","volume":"41","author":"Hoh BL","year":"2010","unstructured":"Hoh BL, Chi YY, Lawson MF,  Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the Nationwide Inpatient Sample database 2002 to 2006. Stroke. 2010;41(2):337\u2013342.10.1161\/STROKEAHA.109.56926920044522"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/2\/article-p456.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/2\/article-p456.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/2\/article-p456.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:07:48Z","timestamp":1794013668000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/2\/article-p456.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":36,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2021.2.jns204420","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,1]]}}}