gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Factors predicting poor outcome from discharge to one year after subarachnoid hemorrhage. The Swiss Study on Subarachnoid Hemorrhage (Swiss SOS)

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  • Christian Fung - Inselspital Universität Bern, Klinik für Neurochirurgie, Bern, Switzerland
  • Martin N. Stienen - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Zürich, Switzerland
  • Ali-Reza Fathi - Hirslanden Klinik Aarau, Aarau, Switzerland
  • Andreas Raabe - Inselspital, Bern University Hospital, Department of Neurosurgery, Bern, Switzerland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Astrid Weyerbrock - Kantonsspital St. Gallen, Klinik für Neurochirurgie, St. Gallen, Switzerland
  • Jan-Karl Burkhardt - Zürich, Switzerland
  • Jürgen Beck - Inselspital Universität Bern, Klinik für Neurochirurgie, Bern, Switzerland
  • Karl Schaller - Hôpitaux Universitaires de Genève, Neurochirurgie, Genève, Switzerland
  • Bawarjan Schatlo - Universitätsklinik Göttingen, Klinik f. Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.08.01

doi: 10.3205/17dgnc042, urn:nbn:de:0183-17dgnc0423

Published: June 9, 2017

© 2017 Fung et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Predictors of poor outcome after subarachnoid hemorrhage have been amply delineated previously. However, data on factors predicting further long-term recovery for patients discharged in a dependent state are scarce.

Methods: The Swiss study on subarachnoid hemorrhage (Swiss SOS) includes all patients treated for SAH since 1st of January 2009 in all eight neurovascular centers in Switzerland. Poor outcome was defined as a modified Rankin scale 3-5, excluding mortality. We analyzed predictors leading to a lack of improvement from dependent to dependent state using multivariate binary logistic regression with a significance level below 0.05.

Results: 1234 surviving patients matched the inclusion criteria for the present analysis. At discharge, 797 patients (64.6%) were reported as independent, while 437 (35.4%) were dependent. At one year, 1050 patients (85.1%) were independent compared to 184 patients with dependent survival (14.9%). 265/437 patients (60.6%) improved from a dependent state at discharge to independent function at one year. Multivariate analysis identified the following factors to be inversely associated with improvement from discharge to one year: Poor WFNS (3-5) (OR 1.89; CI95% 1.36-2.63, p<0.001), high Fisher grade (3,4) (OR 2.04; CI95% 1.08-3.85; p=0.03), chronic hydrocephalus (OR 1.50; CI95% 1.06-2.13; p=0.02) and delayed cerebral ischemia (OR 1.62; CI95% 1.17-2.23; p=0.003).

Conclusion: A majority of patients who are discharged in a dependent state after SAH will regain independent function at one year. Chronic hydrocephalus and delayed cerebral ischemia are the main potentially modifiable variables affecting long-term outcome.