A multicenter study on factors affecting 2-year postoperative survival and prognosis in young patients with aneurysmal subarachnoid hemorrhage
Objective To explore the related factors affecting 2-year postoperative survival and prognosis of young patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective analysis was conducted on the clinical data of 177 young patients(age ≤40 years)with aSAH treated in the Department of Neurosurgery at 12 hospitals including Tianjin Medical University General Hospital from January 2017 to December 2020.According to the treatment methods,they were divided into two groups:aneurysm surgical clipping group(SC group,78 cases)and endovascular coiling group(EC group,99 cases).The clinical data of the two groups of patients were collected and compared,and matched according to a 1∶1 propensity score.The differences in baseline data,complications during hospitalization,and 2-year outcome between the two groups of patients after matching were analyzed.A modified Rankin scale sore(mRS)of 0-2 was defined as a good prognosis.Univariate Cox regression analysis was performed on the matched young aSAH patients.Variables with P＜0.05 in the univariate analysis,gender,and age were included in the multivariate Cox regression model for 2-year survival prognosis analysis.Univariate and multivariate logistic regression analyses were used for analyze the risk factors affecting the 2-year prognosis of young patients with aSAH.The Kaplan-Meier method was used to calculate the 2-year survival rate of the two groups of patients,and the log-rank test was used to compare the difference in survival rates between the two groups.Results After the patients in the SC group and the EC group were matched according to the 1∶1 propensity score(a total of 54 pairs were successfully matched),there were no statistically significant differences in the baseline data of the two groups of patients(including age,gender,Hunt-Hess classification and follow-up time),mortality rate,mRS at discharge and 2 years post surgery,or complications during hospitalization(all P＞0.05).However,the length of hospitalization of patients in the SC group was longer than that of the EC group,and the difference was statistically significant(P=0.001).The results of univariate Cox regression analysis showed that Hunt-Hess grade Ⅳ to Ⅴ,cerebral ischemia,stress ulcer bleeding,abnormal liver function,urinary tract infection,and anemia were risk factors affecting the 2-year survival of young aSAH patients(all P＜0.05);multivariate Cox regression analysis results showed that Hunt-Hess grade Ⅳ to Ⅴwas a risk factor affecting the 2-year survival of young aSAH patients(HR=13.61,95％CI:3.11-59.63,P=0.001).The results of univariate logistic regression analysis showed that Hunt-Hess grade Ⅳ to Ⅴ,postoperative cerebral ischemia and pneumonia were factors affecting the 2-year poor prognosis of young aSAH patients(all P＜0.05).The results of multivariate logistic regression analysis showed that Hunt-Hess grade Ⅳto Ⅴ(OR=8.47,95％CI:1.75-41.05,P=0.008)and postoperative pneumonia(OR=7.54,95％CI:1.36-41.96,P=0.021)were independent risk factors affecting the 2-year poor prognosis of young patients with aSAH.The log-rank test results showed that there was no statistically significant difference in the 2-year survival rate between the SC group and the EC group(92.6％vs.85.2％,P=0.350).Conclusions There is no difference in the 2-year postoperative survival and prognosis of young aSAH patients treated with craniotomy clipping or interventional embolization.The survival and prognosis of young aSAH patients with preoperative Hunt-Hess grade Ⅳ to Ⅴ are often poor,and patients with postoperative pneumonia need to be actively managed.
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