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Propensity-adjusted analysis of ultra-early aneurysmal subarachnoid hemorrhage treatment and patient outcomes

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

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 [14] 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.

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Data Availability

The data utilized for this study consist of individual patient data from a single center and are not publicly available. A release of the de-identified data may be requested if the authors are contacted directly.

Abbreviations

aSAH:

Aneurysmal subarachnoid hemorrhage

CCI:

Charlson Comorbidity Index

DCI:

Delayed cerebral ischemia

HH:

Hunt and Hess

mRS:

Modified Rankin Scale

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Acknowledgements

We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

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Authors and Affiliations

  1. Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA

    Stefan W. Koester, Joshua S. Catapano, Emmajane G. Rhodenhiser, Robert F. Rudy, Ethan A. Winkler, Dimitri Benner, Tyler S. Cole, Jacob F. Baranoski, Visish M. Srinivasan, Christopher S. Graffeo, Ruchira M. Jha, Ashutosh P. Jadhav, Andrew F. Ducruet, Felipe C. Albuquerque & Michael T. Lawton

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  1. Stefan W. Koester
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  2. Joshua S. Catapano
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  15. Michael T. Lawton
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by S. W. Koester and E. G. Rhodenhiser. The first draft of the manuscript was written by S. W. Koester and E. G. Rhodenhiser, and all authors commented on further versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael T. Lawton.

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Ethical approval

This retrospective cohort study was approved by the St. Joseph’s Hospital and Medical Center Institutional Review Board, Phoenix, Arizona, with the requirement for informed consent waived due to the low risk to patients and the study’s retrospective nature.

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The authors declare no competing interests.

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Koester, S.W., Catapano, J.S., Rhodenhiser, E.G. et al. Propensity-adjusted analysis of ultra-early aneurysmal subarachnoid hemorrhage treatment and patient outcomes. Acta Neurochir 165, 993–1000 (2023). https://doi.org/10.1007/s00701-023-05497-7

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