Abstract T P349: Long Term Survival and Hospital Re-Admission Rates in Elderly Patients With Subarachnoid Hemorrhage Treated With Surgical or Endovascular Treatment

Abstract

Background: In International subarachnoid aneurysm trial (ISAT), the 7 year survival was higher among those treated with endovascular treatment compared with surgical treatment. Objective: To determine the long-term survival in elderly patients with subarachnoid hemorrhage who underwent either surgical or endovascular treatment. Methods: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for ruptured intracranial aneurysms with post-procedure follow-up of 2.87 (±2.2) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders. The 5 year survival was estimated for both treatment groups using Kaplan Meir survival methods. We also determined the annual rate of hospital re-admission for both groups during the follow-up period. Results: A total of 724 patients with subarachnoid hemorrhage were treated with either endovascular (n=277) or surgical treatment (n=447). The rate of immediate post-procedural neurological complications (6.3% vs. 2.9%, p=0.04) was higher among patients treated with surgery compared with those treated with endovascular treatment. The estimated 5 year survival was 64.6% and 61.7% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.97, 95% confidence interval [CI] 0.75 - 1.23) was significantly was similar in two groups.