Aneurysm management in patients over 80 years old with good grade subarachnoid haemorrhage

Ewbank, Frederick, Hall, Samuel, Gaastra, Benjamin, Fisher, Benjamin, Coe, Laura, Booker, James, Kaldas, Antony, Anderson, Ian, Critchley, Giles, Teo, Mario, Toma, Ahmed, Trivedi, Rikin, Uff, Chris, Vindlacheruvu, Raghu, Dulhanty, Louise, Javadpour, Mohsen, Walsh, Daniel, Galea, James, Patel, Hiren and Bulters, Diederik (2023) Aneurysm management in patients over 80 years old with good grade subarachnoid haemorrhage. British Journal of Neurosurgery, 1-7. (doi:10.1080/02688697.2023.2205939).

Abstract

Background: An increasing proportion of aneurysmal subarachnoid haemorrhage (aSAH) occurs in older patients, in whom there is widespread variability in treatment rates due to a different balance of risks. Our aim was to compare outcomes of patients over 80 years old with good grade aSAH who underwent treatment of their aneurysm with those who did not. Methods: Adult patients with good grade aSAH admitted to tertiary regional neurosciences centres contributing to the UK and Ireland Subarachnoid Haemorrhage Database (UKISAH) and a cohort of consecutive patients admitted from three regional cohorts were included for analysis. Outcomes were functional outcome at discharge, three months and survival at discharge. Results: In the UKISAH, patients whose aneurysm was treated were more likely to have a favourable outcome at discharge (OR 2.34, CI 1.12–4.91, p =.02), at three months (OR 2.29, CI 1.11–4.76, p =.04), and lower mortality (10% vs. 29%, OR 0.83, CI 0.72–0.94, p <.01). In the regional cohort, a similar pattern was seen, but after correction for frailty and comorbidity there was no difference in survival (HR 0.45, CI 0.12–1.68, p =.24) or favourable outcome at discharge (OR 0.83, CI 0.23–2.94, p =.77) and at three months (OR 1.03, CI 0.25–4.29, p =.99). Conclusions: Better early functional outcomes in those undergoing aneurysm treatment appear to be explained by differences in frailty and comorbidity. Therefore, treatment decisions in this patient group are finely balanced with no clear evidence overall of either benefit or harm in this cohort.

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Contributors

Author: Benjamin Gaastra

Author: Diederik Bulters

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