ABSTRACT
Objective To investigate the relationship between surgical timing and outcomes of aneurysmal subarachnoid hemorrhage (aSAH).Methods The patients with aSAH retrospectively received clipping or endovascular embolization.Their demographic and clinical data were collected.The modified Rankin Scale (mRS) was used to evaluate the outcomes at 6 month after procedure.Univariate and multivariate logistic regression analyses were used to determine the risk factors that influencing clinical outcomes of patients.Results A total of 198 patients with aSAH were enrolled,118 had good outcome (mRS score0-2),80 had poor outcome (mRS score ＞2; 20 of them died); 32 were early operation (operated within 2 d after onset) and 166 were late operation.Univariate analysis showed that the proportions of hypertension (29.66％ vs.52.50％ ; x2 =10.464,P =0.001),cerebral infarction (11.86％ vs.35.00％ ;x2 =15.269,P ＜0.001),cerebral hemorrhage (9.32％ vs.31.25％ ;x2 =15.410,P ＜0.001),Fisher grade 3-4 (22.88％ vs.47.50％ ; x2 =13.104,P ＜ 0.001),Hunt-Hess grade Ⅳ to Ⅴ (19.49％ vs.52.50％ ;x2 =23.557,P ＜0.001),cerebral vasospasm (5.93％ vs.25.0％ ;x2 =14.719,P ＜0.001),hydrocephalus (5.08％ vs.17.50％ ;x2 =8.093,P =0.004),and late operation (78.81％ vs.91.25％ ; x2 =5.442,P =0.020) in patients of the good outcome group were significantly higher than those of the poor outcome group.Multivariatelogistic regression analysis showed that Fisher grade 3 to 4 (odds ratio [OR] 9.13,95％confidence interval [CI] 2.98-13.45; P ＜0.001),Hunt-Hess grade Ⅳ to Ⅴ (OR 6.86,95％ CI 1.57-12.34; P＜0.001),accompanied with hydrocephalus (OR 2.59,95％ CI 1.17-4.31; P=0.024),and late operation (OR 2.17,95％ CI 1.12-3.95; P=0.029) were the independent risk factors for patients with poor clinical outcomes.The univariate analysis for both early operation and late operation groups showed that only the good outcome rate of the early operation group was significantly higher than that of the late operation group (78.13％ vs.56.2％ ;x2 =5.442,P =0.020),and there were no significant differences in the incidences of rebleeding (6.25％ vs.13.25％; x2=1.235,P=0.266),cerebral vasospasm (12.50％ vs.19.28％;x2 =0.042,P=0.834),and hydrocephalus (12.50％ vs.9.64％;x2 =0.242,P=0.623).Conclusion Early operation may significantly improve the outcomes in patients with aSAH.