颅内动脉瘤破裂的夜间治疗与不良预后相关。
Nighttime Treatment of Ruptured Intracranial Aneurysms Are Associated With Poor Outcomes.
作者信息
Dumot Chloe, Gasimov Turab, Hatipoglu Majernik Gokce, Gurbuz Mehmet Sabri, Erginoglu Ufuk, Keles Abdullah, Arat Anil, Baskaya Mustafa K
机构信息
Department of Neurological Surgery, University of Wisconsin-Madison, Madison , Wisconsin , USA.
Department of Neurosurgery, Hospices Civils de Lyon, Lyon , France.
出版信息
Neurosurgery. 2025 Jan 1;96(1):78-86. doi: 10.1227/neu.0000000000003024. Epub 2024 Jun 21.
BACKGROUND AND OBJECTIVES
Rebleeding of ruptured intracranial aneurysms (RIA) is associated with poor outcomes. Although immediate treatment of RIAs is preferred, optimal treatment timing is multifactorial and may be a complicating factor for achieving the best outcomes. The objective of this study was to compare outcomes for patients with RIAs as a function of treatment time of day. To the best of our knowledge, this is the first study that examines how treatment time of day influences treatment outcomes.
METHODS
This retrospective single-center study included all patients who were treated, either surgically or endovascularly, for RIAs within 24 hours after admission. Exclusion criteria were blister, mycotic or giant aneurysms, or incomplete records. The modified Rankin Scale was used to evaluate treatment outcomes using multivariate analysis. Nighttime treatment was defined when greater than 50% of the procedure was performed between 10 pm and 7 am , with other times classified as daytime treatment. Off-hours treatment was defined when more than 50% of the procedure was performed between 7 pm and 7 am , with other times classified as on-hours.
RESULTS
This study included 493 patients, with 84.2% (415) treated during the daytime, 15.8% (78) during the nighttime, 67.5% (333) during on-hours, and 32.5% (160) during off-hours. These groups did not differ according to age, sex, World Federation of Neurosurgical Societies and Fisher scales, aneurysm size, location, and surgical or endovascular treatment. Outcomes were favorable (modified Rankin Scale 0-2) for 72.0% (299) of patients treated during the daytime and 60.0% (46) of patients treated during the nighttime. Aneurysm treatment during the nighttime (OR: 0.50 [95% CI: 0.28-0.91], P = .023) but not during off-hours (OR: 0.76 [0.50-1.14], P = .18) was independently associated with unfavorable outcomes.
CONCLUSION
Nighttime treatment was associated with poorer outcomes. Further studies are needed to evaluate outcomes if treatment is postponed to daytime hours.
背景与目的
颅内破裂动脉瘤（RIA）再出血与不良预后相关。尽管RIA的即刻治疗是首选，但最佳治疗时机受多种因素影响，可能是实现最佳预后的一个复杂因素。本研究的目的是比较RIA患者的预后与治疗时间的关系。据我们所知，这是第一项研究一天中的治疗时间如何影响治疗结果的研究。
方法
这项回顾性单中心研究纳入了所有在入院后24小时内接受手术或血管内治疗的RIA患者。排除标准为泡状、霉菌性或巨大动脉瘤，或记录不完整。采用改良Rankin量表通过多变量分析评估治疗结果。夜间治疗定义为超过50%的手术在晚上10点至早上7点之间进行，其他时间归类为白天治疗。非工作时间治疗定义为超过50%的手术在晚上7点至早上7点之间进行，其他时间归类为工作时间。
结果
本研究纳入493例患者，其中84.2%（415例）在白天接受治疗，15.8%（78例）在夜间接受治疗，67.5%（333例）在工作时间接受治疗，32.5%（160例）在非工作时间接受治疗。这些组在年龄、性别、世界神经外科学会联合会和Fisher分级、动脉瘤大小、位置以及手术或血管内治疗方面无差异。白天接受治疗的患者中72.0%（299例）预后良好（改良Rankin量表0 - 2级），夜间接受治疗的患者中60.0%（46例）预后良好。夜间进行动脉瘤治疗（比值比：0.50 [95%置信区间：0.28 - 0.91]，P = 0.023）而非非工作时间治疗（比值比：0.76 [0.50 - 1.14]，P = 0.18）与不良预后独立相关。
结论
夜间治疗与较差的预后相关。如果将治疗推迟到白天，需要进一步研究评估预后情况。
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