Massive Cerebrospinal Fluid Replacement Reduces Delayed Cerebral Vasospasm After Embolization of Aneurysmal Subarachnoid Hemorrhage

Clinical Analysis of Poor Outcomes After Surgery for Aneurysmal Subarachnoid Hemorrhage in Guizhou, China

OBJECTIVE

To investigate poor outcomes of aneurysmal subarachnoid hemorrhage (aSAH) and compare the clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications of patients with good and poor outcomes to identify potential risk factors.

METHODS

We retrospectively analyzed patients with aSAH who underwent surgery in Guizhou, China, between June 1, 2014, and September 1, 2022. The Glasgow Outcome Scale was used to evaluate outcomes at discharge, with scores of 1-3 and 4-5 considered poor and good, respectively. Clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications were compared between patients with good and poor outcomes. Multivariate analysis was used to determine independent risk factors for poor outcomes. The poor outcome rate of each ethnic group was compared.

RESULTS

Of 1169 patients, 348 were ethnic minorities, 134 underwent microsurgical clipping, and 406 had poor outcomes at discharge. Patients with poor outcomes were older, represented fewer ethnic minorities, had a history of comorbidities, experienced more complications, and underwent microsurgical clipping. The top 3 types of aneurysms were anterior, posterior communicating, and middle cerebral artery aneurysms.

CONCLUSIONS

Outcomes at discharge varied according to ethnic group. Han patients had worse outcomes. Age, loss of consciousness at onset, systolic blood pressure on admission, Hunt-Hess grade 4-5 on admission, epileptic seizures, modified Fisher grade 3-4, microsurgical clipping, size of the ruptured aneurysm, and cerebrospinal fluid replacement were independent risk factors for aSAH outcomes.