The Analysis Of Risk Factors For The Hospital Surgical Outcome Of Aneurysmal Subarachnoid Hemorrhage(aSAH)

Objective: The purpose of this study was to retrospectively analyze the hospital surgical outcome and relevant factors of craniotomy clipping and endovascular treatment of aneurysmal subarachnoid hemorrhage(a SAH).Methods: During the period of March 2011 to May 2014 in tianjin medical university general hospital,236 persons with a SAH underwent either neurosurgical clipping or endovascular treatment in the neurosurgery department,135 patients with neurosurgical clipping and 101 patients with endovascular treatments.The patients’ datas that contained the basic characteristics,past medical history,clinical state on admission,postoperative complications,and m RS score at the time of discharge of the two groups were added up and analyzed.The factors related to unfavorable hospital outcome was analyzed by univariate analysis and multivariate regression analysis.Next,the hospital outcome of patients that were ≥65 years was analyzed.The factors related to the death in the process of treatment were also studied.Finally,the research explored the factors of hospital outcome of preoperative poor-grade(grade-Ⅳ and Ⅴ of WFNS)a SAH.Results: The prevalence of poor hospital outcome was higher in endovascular treatments compared to neurosurgical clipping(25.7% vs.17.0%),but not significant(p=0.103).When discharged from hospital,the hospital mortality of endovascular treatments(17.8%)was significantly higher than neurosurgical clipping(5.9%)(p=0.004).Morever,the average age of endovascular group was significantly higher than the neurosurgical clipping group(p=0.01).Multivariate analysis showed that:(1)preoperative WFNS grade(p=0.025),delayed cerebral ischemia(DCI,p=0.005,OR=4.45),rebleeding(p < 0.001,OR=57.16),postoperative pulmonary infection(p=0.036,OR=3.284)and cardiac diseases(p=0.033,OR=8.414)were independently associated with poor hospital outcome of treatment.(2)preoperative WFNS grade(p < 0.001,OR=2.7),DCI(p=0.045,OR=4.1)and rebleeding(p=0.003,OR=31.4)were independent risk factors for poor hospital outcome of neurosurgical clipping;houever,preoperative WFNS grade(p=0.045,OR=1.72)、rebleeding(p<0.001,OR=31.23)and postoperative pulmonary infection(p=0.036,OR=6.50)were independently associated with poor hospital outcome of endovascular treatments.(3)preoperative WFNS grade(p=0.019,OR=1.8)and postoperative hydrocephalus(p=0.030,OR=12.3)were independently associated with the poor outcome of patients that were ≥ 65 years.(4)rebleeding(p=0.001,OR=21.539)、postoperative cardiac diseases(p=0.039,OR=13.511)and pulmonary infection(p=0.047,OR=7.015)were independent risk factors for hospital mortality of endovascular treatments;however,only the Fisher CT grade(p=0.024,OR=1.263)was independent risk factors for the hospital mortality of relatively younger neurosurgical clipping group.(5)The higher grade Hunt-Hess(grade 4 and 5)was independent risk factors for the poor hospatal outcome of patients with preoperative poor-grade(grade-Ⅳ and Ⅴ of WFNS).Conclusion: The preoperative pathogenetic condition grade,especially WFNS grade,postoperative complications and comorbidities were the primary factors associated with hospital poor outcome and hospital death,however,the age of patients was relatively unimportant to the hospital outcome.The independent risk factors for the hospital outcome of endovascular treatments were different from the risk factors of neurosurgical clipping.The primary factors related to the hospital poor outcome of patients with preoperative poor-grade was higher Hunt-Hess grade.