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Rehman S, Chandra RV, Zhou K, Tan D, Lai L, Asadi H, Froelich J, Thani N, Nichols L, Blizzard L, Smith K, Thrift AG, Stirling C, Callisaya ML, Breslin M, Reeves MJ, Gall S. Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome. Acta Neurochir (Wien) 2020; 162:2271-2282. [PMID: 32607744 DOI: 10.1007/s00701-020-04469-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes. METHODS In a retrospective cohort (2010-2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders. RESULTS Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90-1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76-1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87-1.48; death RRR 0.75 95% CI 0.51-1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69-1.11; death RRR 0.80 95% CI 0.52-1.23). Results were consistent in propensity score matched models. CONCLUSION The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | - Ronil V Chandra
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Kevin Zhou
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Darius Tan
- Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Leon Lai
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Jens Froelich
- NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nova Thani
- Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Linda Nichols
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | | | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | | | - Michele L Callisaya
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia
| | - Mathew J Reeves
- Department of Epidemiology, Michigan State University, East Lansing, MI, USA
| | - Seana Gall
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia.
- Monash University, Melbourne, Victoria, Australia.
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