Impact of Age On Short-Term Outcomes After Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

Abstract

Changes in outcome after discharge of patients with aneurysmal subarachnoid hemorrhage (aSAH) have not been examined in detail in recent aging society. This study aimed to clarify the prevalence and factors of changes in outcome in these patients based on a registry database in Japan. Overall, 1,111 radically treated patients with aSAH in the acute stage were selected between January 2010 and December 2012 for inclusion in the modified World Federation of Neurosurgical Societies (mWFNS) scale study. The modified Rankin Scale (mRS) score at discharge and 3 months after onset, prevalence of improvement and decline between these two periods, and their factors were evaluated by age groups through multivariate logistic regression analysis. The rates of improvement and decline were 28.4% and 2.4%, respectively. Factors that improved the mRS score were WFNS and mWFNS scale grade Ⅳ versus (vs.) Ⅰ (odds ratio: 0.47, 95% confidence interval: 0.31–0.71), grade Ⅴ vs. Ⅰ (0.49, 0.31–0.76), and cerebral vasospasm category 4 vs. 1 (0.43, 0.25–0.77). Factors that decreased the mRS score were pre-elderly (65–74 years) vs. non-elderly (<65 years) (5.65, 1.09–29.20), elderly (≥75 years) vs. non-elderly (19.20, 2.36–156.50), WFNS scale grade III vs. I, and aneurysmal location. Mild neurological grade on admission and no cerebral infarction due to cerebral vasospasm were the factors improving outcomes, and aging was a factor declining outcomes between discharge and at 3 months after onset. Careful assessment timing of outcome in elderly patients is needed in the future aging society.