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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Survival and outcome after poor-grade aneurysmal subarachnoid haemorrhage in elderly patients

Überleben und Behandlungsergebnisse nach schwerer aneurysmatischer Subarachnoidalblutung in alten Patienten

Meeting Abstract

  • presenting/speaker Johannes Goldberg - Inselspital Bern, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Daniel Schoeni - Inselspital Bern, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Pasquale Mordasini - Inselspital Bern, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Werner Z’Graggen - Inselspital Bern, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Jan Gralla - Inselspital Bern, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Andreas Raabe - Inselspital Bern, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Christian Fung - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP125

doi: 10.3205/19dgnc461, urn:nbn:de:0183-19dgnc4612

Published: May 8, 2019

© 2019 Goldberg 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

Text

Objective: Whether maximal treatment should be offered to elderly patients suffering from poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is controversial. The survival of patients in this subgroup beyond the usual outcome measurements 6 to 12 months after aSAH is unclear. The purpose of this study is to provide survival and outcome data to support clinicians making decisions on treatment for this subgroup of patients.

Methods: We performed a retrospective analysis of the Bernese SAH database for poor-grade (World Federation of Neurosurgical Societies grade IV and V) elderly patients (age ≥60 years) suffering from aSAH admitted to our institution from 2005 to 2017. Patients were divided into 3 age groups (60–69, 70–79, and 80–90 years). Survival analysis was performed to estimate mean survival and hazard ratios for death. Binary logarithmic regression was used to estimate the odds ratio for favorable (modified Rankin Scale score of 0–3) and unfavorable (modified Rankin Scale score of 4–6) outcome.

Results: Increasing age was associated with an increasing risk of death after aSAH. The hazard ratio increased by 6% per year of age (P<0.001; hazard ratio, 1.06; 95% CI, 1.03–1.09) and 76% per decade (P<0.001; hazard ratio, 1.76; 95% CI, 1.35–2.29). Mean survival was 56.3±8 months (patients aged 60–69 years), 31.6±7.6 months (70–79 years), and 7.6±5.8 months (80–90 years). Unfavorable outcomes 6 to 12 months after aSAH were strongly related to older age. The odds ratio increased by 11% per year of age (P<0.001; odds ratio, 1.11; 95% CI, 1.05–1.18) and 192% per decade (P<0.001; odds ratio, 2.92; 95% CI, 1.63–5.26).

Conclusion: Risk for death and unfavorable outcome increases markedly with higher age in elderly patients with poor-grade aSAH. Despite a high initial mortality, treatment resulted in a reasonable proportion of favorable outcomes up to 79 years of age and only a small number of patients who were moderately or severely disabled 6 to 12 months after aSAH. Mean survival and proportion of favorable outcomes decreased markedly in patients older than 80 years.

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