Timing of aneurysm treatment in subarachnoid hemorrhage and grade of functional capacity at discharge: a retrospective cohort study

Abstract

BackgroundAneurysmal subarachnoid hemorrhage (SAH) is a vascular pathology with high morbidity and mortality that requires timely management to reduce the risk of complications. However, the ideal time for aneurysm clipping is still controversial. This study aimed to compare the degree of functional capacity at discharge of patients who underwent surgery for rupture of a cerebral aneurysm at different periods of time until surgery.Results132 patients who underwent surgery for SAH due to aneurysm rupture were included. The mean age was 52.5 years and 69.7% of participants were female. At admission, 96.2% were given a score of 1–3 on the World Federation of Neurological Surgeons scale and 79.6% received a score of 1–2 on the Hunt Hess scale. 8.3% of cases underwent surgery within the first 3 days of bleeding. The average time from clinical manifestation to surgical intervention was 7.1 days. At discharge 77.27% of patients presented good functional capacity. After adjusting for confounders, multivariate analysis showed a trend towards increased, albeit not statistically significant, risk in patients undergoing surgery at between 4 and 10 days (RR = 2.95 95% CI 0.80–10.87) and at > 10 days after SAH (RR = 2.65. 95% CI 0.72–9.79).ConclusionsDespite the trend towards a higher probability of presenting poor functional capacity at discharge in patients undergoing aneurysm clipping more than 3 days after SAH, the differences were not statistically significant. There is a need for prospective randomized studies evaluating the best time to clip aneurysms, since aneurysm clipping is still a routine procedure in many countries.