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Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome

  • Original Article - Vascular Neurosurgery - Aneurysm
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Abstract

Background

Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes.

Methods

In a retrospective cohort (2010–2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders.

Results

Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90–1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76–1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87–1.48; death RRR 0.75 95% CI 0.51–1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69–1.11; death RRR 0.80 95% CI 0.52–1.23). Results were consistent in propensity score matched models.

Conclusion

The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.

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Acknowledgements

We gratefully thank Gemma Kitsos for creating the database and managing the project, Sue Mosley for data collection in Victoria, and Chao Zhu for statistical help (PhD candidate).

Funding

REDDISH (REducing Delays In aneurysmal Subarachnoid Hemorrhage) was funded by the National Health and Medical Research Council of Australia (NHMRC APP1143155).

Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia

    Sabah Rehman, Leigh Blizzard, Michele L. Callisaya, Monique Breslin & Seana Gall

  2. NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia

    Ronil V. Chandra, Kevin Zhou & Hamed Asadi

  3. School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia

    Ronil V. Chandra & Leon Lai

  4. Neurosurgery, Monash Health, Melbourne, Victoria, Australia

    Darius Tan & Leon Lai

  5. NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia

    Jens Froelich

  6. Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia

    Nova Thani

  7. School of Nursing, University of Tasmania, Hobart, Tasmania, Australia

    Linda Nichols & Christine Stirling

  8. Ambulance Victoria, Victoria, Australia

    Karen Smith

  9. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia

    Amanda G. Thrift

  10. Monash University, Melbourne, Victoria, Australia

    Michele L. Callisaya & Seana Gall

  11. Department of Epidemiology, Michigan State University, East Lansing, MI, USA

    Mathew J. Reeves

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  1. Sabah Rehman
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  2. Ronil V. Chandra
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  3. Kevin Zhou
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  9. Linda Nichols
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Contributions

S. Rehman acquired, analysed and interpreted data, drafted the manuscript; R.V. Chandra, K. Smith, N. Thani designed the study, acquired and interpreted data, provided critical intellectual content to draft; K. Zhou and D. Tan acquired and interpreted data, provided critical intellectual content to draft; L. Lai, H. Asadi, M. Reeves, M. Breslin, M. Callisaya interpreted data and provided critical intellectual content to draft; A. Thrift, J. Froelich, L. Nichols, S Gall, L Blizzard and C Stirling designed the study, interpreted data, provided critical intellectual content to draft. All authors approve the final version of the manuscript.

Corresponding author

Correspondence to Seana Gall.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Human Research Ethics Committee in Victoria (RES-18-0000-036A) and Tasmania (H0014563). For this retrospective study formal consent is not required.

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Rehman, S., Chandra, R.V., Zhou, K. et al. Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome. Acta Neurochir 162, 2271–2282 (2020). https://doi.org/10.1007/s00701-020-04469-5

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