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- Title
Treatment of octogenarians and nonagenarians with aneurysmal subarachnoid hemorrhage: a 17-year institutional analysis.
- Authors
Catapano, Joshua S.; Rumalla, Kavelin; Srinivasan, Visish M.; Labib, Mohamed A.; Nguyen, Candice L.; Baranoski, Jacob F.; Cole, Tyler S.; Rutledge, Caleb; Rahmani, Redi; Zabramski, Joseph M.; Jadhav, Ashutosh P.; Ducruet, Andrew F.; Albuquerque, Felipe C.; Lawton, Michael T.
- Abstract
Background: Outcomes for octogenarians and nonagenarians after an aneurysmal subarachnoid hemorrhage (aSAH) are particularly ominous, with mortality rates well above 50%. The present analysis examines the neurologic outcomes of patients ≥ 80 years of age treated for aSAH. Method: A retrospective review was performed of all aSAH patients treated at Barrow Neurological Institute from January 1, 2003, to July 31, 2019. Patients were placed in 2 groups by age, < 80 vs ≥ 80 years. The ≥ 80-year-old group of octogenarians and nonagenarians was subsequently analyzed to compare treatment modalities. Poor neurologic outcome was defined as a modified Rankin Scale (mRS) score of > 2. Results: During the study period, 1418 patients were treated for aSAH. The mean (standard deviation) age was 55.1 (13.6) years, the mean follow-up was 24.6 (40.0) months, and the rate of functional independence (mRS 0–2) at follow-up was 54% (751/1395). Logistic regression analysis found increasing age strongly associated with declining functional independence (R2 = 0.929, p < 0.001). Forty-three patients ≥ 80 years old were significantly more likely to be managed endovascularly than with open microsurgery (67% [n = 29] vs 33% [n = 14], p < 0.001). Compared with younger patients, those ≥ 80 years old had an increased risk of mortality and poor neurologic outcomes at follow-up. In the ≥ 80-year-old group, only 4 patients had good outcomes; none of the 4 had preexisting comorbidities, and all 4 were treated endovascularly. Conclusions: Age is a significant prognostic indicator of functional outcomes and mortality after aSAH. Most octogenarians and nonagenarians with aSAH will become severely disabled or die.
- Subjects
SUBARACHNOID hemorrhage; AGE groups; LOGISTIC regression analysis; TREATMENT effectiveness; FUNCTIONAL status; OCTOGENARIANS; NONAGENARIANS
- Publication
Acta Neurochirurgica, 2021, Vol 163, Issue 11, p2941
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-021-04985-y