Long-term outcomes, including the survival rate and period to death, in patients over 80 years old after ruptured cerebral aneurysm clipping

Yoshitaka Kubo; Takahiro Koji; Shunrou Fujiwara; Kohei Chida; Yosuke Akamatsu; Hiroshi Kashimura; Kuniaki Ogasawara

doi:10.1016/j.jstrokecerebrovasdis.2022.106691

Long-term outcomes, including the survival rate and period to death, in patients over 80 years old after ruptured cerebral aneurysm clipping

J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106691. doi: 10.1016/j.jstrokecerebrovasdis.2022.106691. Epub 2022 Aug 3.

Authors

Yoshitaka Kubo¹, Takahiro Koji², Shunrou Fujiwara³, Kohei Chida⁴, Yosuke Akamatsu⁵, Hiroshi Kashimura⁶, Kuniaki Ogasawara⁷

Affiliations

¹ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: yokubo@iwate-med.ac.jp.
² Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: thkoji@iwate-med.ac.jp.
³ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: shunfuji@iwate-med.ac.jp.
⁴ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: kchida@iwate-med.ac.jp.
⁵ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: akamatsu@iwate-med.ac.jp.
⁶ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: hkashimura@icloud.com.
⁷ Department of Neurosurgery, Iwate Medical University, Japan. Electronic address: kuogasa@iwate-med.ac.jp.

PMID: 35932541
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106691

Abstract

Objective: 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.

Materials and methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Clipping; Long-term outcome; Over 80 years; Ruptured cerebral aneurysm.

Publication types

Observational Study

MeSH terms

Aged, 80 and over
Aneurysm, Ruptured* / diagnostic imaging
Aneurysm, Ruptured* / surgery
Embolization, Therapeutic* / methods
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / surgery
Stroke*
Subarachnoid Hemorrhage* / diagnostic imaging
Subarachnoid Hemorrhage* / surgery
Survival Rate
Treatment Outcome