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Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach

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Abstract

The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60–69, 70–79, and ≥80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60–69, 93 aged 70–79, 25 aged ≥80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1–154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I–III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I–III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.

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Acknowledgments

We thank Ms. Katja Laspe (Department of Neurosurgery, University of Giessen Medical Center) for proofreading of the manuscript.

Conflicts of interest

None.

Ethical standard

All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Karsten Schöller, Maike Massmann, Mathias Kunz, Jörg-Christian Tonn & Christian Schichor

  2. Institute for Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Gunther Fesl & Hartmut Brückmann

  3. Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Thomas Pfefferkorn

  4. Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany

    Gertraud Markl

  5. Department of Neurosurgery, University of Giessen Medical Center, Klinikstr. 33, 35392, Giessen, Germany

    Karsten Schöller

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  1. Karsten Schöller
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  2. Maike Massmann
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  3. Gertraud Markl
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  4. Mathias Kunz
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  9. Christian Schichor
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Correspondence to Karsten Schöller.

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Schöller, K., Massmann, M., Markl, G. et al. Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach. J Neurol 260, 1052–1060 (2013). https://doi.org/10.1007/s00415-012-6758-1

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  • DOI: https://doi.org/10.1007/s00415-012-6758-1

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