gms | German Medical Science

Objective: Subarachnoid hemorrhage (SAH) is a live threatening situation. Many patients die or are severely disabled. However, due to advantages in aneurysm occlusion, intensive care treatment and rehabilitation, a reasonable number of patients can reach a favorable outcome in means of independency in daily concerns. Re-entry into working life is another important step of recovery – in personal, social and financial aspects. Re-entry to working life enables complete autonomy in those patients lives and avert depression.

Methods: Patients with non-traumatic SAH which were treated in our institution between 2007 and 2015 and aged between 20 and 60 years were analyzed. Diagnostic and treatment was performed due to standardized protocols. If an aneurysm was identified as source of the SAH, treatment decision was based on an interdisciplinary approach. Clinical data and treatment course were entered in our prospectively kept database. At 6^th month follow up, work status, social recovery and outcome per modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) was assessed in 605 patients via outpatient visits or structured telephone interview when necessary.

Results: Favorable outcome (mRS 0-2) at 6^th month follow up was achieved in 66.3%, and 263 patients (43.5%) were already able to work again at this time. Prognostic factors for re-entry into working life were: younger age, good admission status, no intracerebral or subdural hemorrhage, non-aneurysmal SAH, small aneurysm size, endovascular aneurysm treatment, no early hydrocephalus or shunt dependency at follow up (each item: p<0.001). Women did significantly less often re-enter working life at the time of follow up than men (40% vs. 49%; p<0.001). Multivariate analysis revealed sex, good admission status, no intracerebral hemorrhage, no hydrocephalus and endovascular treatment as strongly related with re-entering working life.

Conclusion: Due to structured treatment and interdisciplinary approach, in combination with an intensive rehabilitation system, more than 40% of patients were back at work 6^th month after non-traumatic SAH. Even though, sex is not associated with favorable outcome, gender is - beside the known prognostic factors in SAH patients - strongly associated with this feature of excellent recovery. Why women do less often reenter working life after SAH seems to be associated with social structures, but needs to be further investigated.