Propensity-adjusted analysis of ultra-early aneurysmal subarachnoid hemorrhage treatment and patient outcomes
BACKGROUND: Optimal definitive treatment timing for patients with aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. We compared outcomes for aSAH patients with ultra-early treatment versus later treatment at a single large center. METHOD: Patients who received definitive open surgical or endovascular treatment for aSAH between January 1, 2014, and July 31, 2019, were included. Ultra-early treatment was defined as occurring within 24 h from aneurysm rupture. The primary outcome was poor neurologic outcome (modified Rankin Scale score > 2). Propensity adjustment was performed for age, sex, Charlson Comorbidity Index, Hunt and Hess grade, Fisher grade, aneurysm treatment type, aneurysm type, size, and anterior location. RESULTS: Of the 1013 patients (mean [SD] age, 56  years; 702 [69%] women, 311 [31%] men) included, 94 (9%) had ultra-early treatment. Compared with the non-ultra-early cohort, the ultra-early treatment cohort had a significantly lower percentage of saccular aneurysms (53 of 94 [56%] vs 746 of 919 [81%], P <0 .001), greater frequency of open surgical treatment (72 of 94 [77%] vs 523 of 919 [57%], P <0 .001), and greater percentage of men (38 of 94 [40%] vs 273 of 919 [30%], P = .04). After adjustment, ultra-early treatment was not associated with neurologic outcome in those with at least 180-day follow-up (OR = 0.86), the occurrence of delayed cerebral ischemia (OR = 0.87), or length of stay (exp(β), 0.13) (P ≥ 0.60). CONCLUSIONS: In a large, single-center cohort of aSAH patients, ultra-early treatment was not associated with better neurologic outcome, fewer cases of delayed cerebral ischemia, or shorter length of stay.
Medical Subject Headings
Male; Humans; Female; Middle Aged; Subarachnoid Hemorrhage (diagnosis, surgery); Retrospective Studies; Brain Ischemia; Aneurysm, Ruptured (diagnosis, surgery); Cerebral Infarction; Treatment Outcome
Digital Object Identifier (DOI)
Koester, Stefan W.; Catapano, Joshua S.; Rhodenhiser, Emmajane G.; Rudy, Robert F.; Winkler, Ethan A.; Benner, Dimitri; Cole, Tyler S.; Baranoski, Jacob F.; Srinivasan, Visish M.; Graffeo, Christopher S.; Jha, Ruchira M.; Jadhav, Ashutosh P.; Ducruet, Andrew F.; Albuquerque, Felipe C.; and Lawton, Michael T., "Propensity-adjusted analysis of ultra-early aneurysmal subarachnoid hemorrhage treatment and patient outcomes" (2023). Neurology. 1361.