BACKGROUND:There is no consensus regarding the optimal timing for surgery for poor-grade aneurysmal subarachnoid hemorrhage.OBJECTIVE:To retrospectively evaluate variation in patient characteristics and outcomes between early and delayed surgery groups.METHODS:Poor-grade aneurysmal subarachnoid hemorrhage was defined as a World Federation of Neurosurgical Societies grade of IV or V after resuscitation. Early surgery was defined as surgery performed within 72 hours of ictus, and delayed surgery was defined as surgery after 72 hours. Outcomes were assessed by modified Rankin score. The mean time of follow-up was 12.5 3.4 months.RESULTS:Of the 118 patients included in the study, 80 (68%) underwent early surgery and 38 (32%) underwent delayed surgery. Patients with brain herniation (P < .001) and a lower Fisher grade (P = .02) more often underwent early surgery. Patients in the early group more often underwent decompressive craniectomy (P < .001). Postoperative complications and length of hospital stay did not differ, and outcomes were similar between the 2 groups. Forty (34%) patients had an excellent outcome (modified Rankin score 0-1). Multivariate analysis showed a slight trend toward an excellent outcome in the early surgery group. Younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were independent predictors of an excellent outcome.CONCLUSION:Although patients with brain herniation and a lower Fisher grade were more likely to undergo early surgery, there was a slight trend toward an excellent outcome in the early surgery group. Patients with a younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were more likely to experience an excellent outcome.ABBREVIATIONS:aSAH, aneurysmal subarachnoid hemorrhageCI, confidence intervalDC, decompressive craniectomyICH, intracerebral hematomaIVH, intraventricular hemorrhageMCA, middle cerebral arterymRS, modified Rankin scoreOR, odds ratioWFNS, World Federation of Neurosurgical Societies
基金：
National Key Technology Research and Development Program of the Ministry of Science and Technology of ChinaNational Key Technology R&D Program [2013BAI09B03, 2011BAI08B06]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81471210]; Chinese Ministry of Health [WKJ2010-2-016]; Wenzhou Bureau of Science and Technology [Y20090005]
第一作者机构：[1]Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Beijing Inst Brain Disorders, Dept Neurosurg,Beijing Tiantan Hosp,Ctr Stroke, Beijing, Peoples R China;[2]Wenzhou Med Univ, Affiliated Hosp 1, Dept Neurosurg, Wenzhou, Peoples R China;[3]Mayo Clin, Dept Neurosurg, Rochester, MN USA;
通讯作者：
通讯机构：[1]Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Beijing Inst Brain Disorders, Dept Neurosurg,Beijing Tiantan Hosp,Ctr Stroke, Beijing, Peoples R China;[2]Wenzhou Med Univ, Affiliated Hosp 1, Dept Neurosurg, Wenzhou, Peoples R China;[4]Wenzhou Med Univ, Affiliated Hosp 1, Dept Neurosurg, Nanbai Xiang Town 325000, Wenzhou, Peoples R China;[5]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, 6 TiantanXili, Beijing 100050, Peoples R China
推荐引用方式(GB/T 7714)：
Zhao Bing,Tan Xianxi,Zhao Yuanli,et al.Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage[J].NEUROSURGERY.2016,78(2):224-231.doi:10.1227/NEU.0000000000001038.
APA：
Zhao, Bing,Tan, Xianxi,Zhao, Yuanli,Cao, Yong,Wu, Jun...&Wang, Shuo.(2016).Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.NEUROSURGERY,78,(2)
MLA：
Zhao, Bing,et al."Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage".NEUROSURGERY 78..2(2016):224-231
医学