Effect of Early Aneurysm Surgery On Prognosis: Calm Down In A Hurry!

Abstract

This study investigates the effects of early surgery in aneurysmal subarachnoid hemorrhage (SAH) on the outcome and postoperative complications. This retrospective study includes 250 patients who presented to a teaching hospital with SAH and underwent aneurysm clipping during a 10-year period. 212 patients (84.8%) underwent early, and 38 (15.2%) underwent late surgery. Presenting symptoms, clinical and neuroradiological findings, and outcomes were reviewed. The severity of SAH was assessed using the World Federation of Neurosurgical Societies (WFNS) SAH scale and Fisher’s grading system. Glasgow Outcome Scale (GOS) was used for postoperative outcome measures. Patients consisted of 142 (56.8%) females and 108 (43.2%) males with a mean age of 52.5 years and a female-to-male ratio of 1.3. The most common presenting symptoms were headache and vomiting (n=164; 65.6%). The incidence of SAH was highest in fall and spring, respectively. The patients were mostly classified as grade 1 on the WFNS SAH scale and as grade 2 on Fisher’s scale. A significant correlation was found between WFNS and Fisher’s grades and GOS. The majority of patients underwent early aneurysm surgery, and re-bleeding occurred in 4.3%. Mortality was 10.3%, and vasospasm-related morbidity and mortality occurred in 6% and 6.8% of the patients, respectively. 84.8% of patients had favorable outcomes, and 15.2% of patients had poor outcomes. Results showed that early surgery led to reduced morbidity and mortality. Patients admitted with SAH should be promptly evaluated and undergo angiography. Subsequently, the aneurysm should be promptly excluded from circulation to prevent rebleeding, thus enabling the team to concentrate on managing other complications. © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.