Department of Neurosurgery, Iwate Medical University, Japan.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106691. doi: 10.1016/j.jstrokecerebrovasdis.2022.106691. Epub 2022 Aug 3.
This study aimed to identify the long-term outcomes, including the survival rate, period to death, causes of death, and predictors of poor outcomes, in patients aged over 80 years who underwent surgical clipping for a ruptured anterior circulation aneurysm.
In this retrospective observational study, the medical records of patients from April 1, 1994, to June 30, 2019, were evaluated. All patients underwent surgical clipping within 72 h of subarachnoid hemorrhage (SAH) onset. Information on the patient, SAH, and outcomes were collected.
The mean hospitalization and long-term follow-up periods for all patients were 54.5 days and 53.3 months, respectively. The period to death was significantly shorter in patients with modified Rankin scale (mRS) of 4-5 than for those with an mRS of 0-3 at discharge (p=0.001). The Kaplan-Meier method using the log-rank test demonstrated that patients with an mRS of 4-5 at discharge had a significantly lower survival rate compared to those with an mRS of 0-3 at discharge (p<0.05). Univariate analysis revealed that the proportion of patients with Hunt and Hess grade and presence of surgical complications were significantly larger in the group with an mRS of 4-5 than in that with an mRS of 0-3 at discharge (p=0.0013 and 0.011, respectively). Multivariate analysis demonstrated that presence of surgical complications was the only independent predictor of poor outcomes (p=0.043, odds ratio [OR] 7.937, 95% confidence interval [CI] 1.061-59.38). The Kaplan-Meier method using the log-rank test demonstrated that patients with surgical complications had a significantly lower survival rate compared to those with no surgical complications (p<0.05).
Especially in patients aged over 80 years, those with H-H grade 2 and a good clinical condition can be candidates for surgical clipping, whereas avoiding surgical complications is essential for achieving good outcomes.
本研究旨在确定 80 岁以上接受手术夹闭治疗破裂前循环动脉瘤患者的长期预后，包括生存率、死亡时间、死亡原因以及不良预后的预测因素。
在这项回顾性观察研究中，评估了 1994 年 4 月 1 日至 2019 年 6 月 30 日期间的患者病历。所有患者均在蛛网膜下腔出血（SAH）发作后 72 小时内接受手术夹闭。收集患者、SAH 和结局相关信息。
所有患者的平均住院和长期随访时间分别为 54.5 天和 53.3 个月。改良Rankin 量表（mRS）评分 4-5 分的患者与出院时 mRS 评分 0-3 分的患者相比，死亡时间明显缩短（p=0.001）。使用对数秩检验的 Kaplan-Meier 法显示，出院时 mRS 评分 4-5 分的患者的生存率明显低于出院时 mRS 评分 0-3 分的患者（p<0.05）。单因素分析显示，出院时 mRS 评分 4-5 分的患者中，Hunt 和 Hess 分级比例和手术并发症的比例明显大于 mRS 评分 0-3 分的患者（p=0.0013 和 0.011）。多因素分析显示，手术并发症是不良预后的唯一独立预测因素（p=0.043，优势比[OR]7.937，95%置信区间[CI]1.061-59.38）。使用对数秩检验的 Kaplan-Meier 法显示，有手术并发症的患者的生存率明显低于无手术并发症的患者（p<0.05）。
特别是对于 80 岁以上的患者，H-H 分级为 2 级且临床状况良好的患者可以选择手术夹闭治疗，而避免手术并发症是实现良好预后的关键。
