title: Treatment outcome of aneurysmal subarachnoid hemorrhage in patients aged 70 years and older.
abstract: BACKGROUND
  The incidence of subarachnoid hemorrhage is increasing, especially in the elderly as life expectancy increases. Aggressive treatment of aneurysms in the elderly is usually avoided because of a presumed poor prognosis.
  
  
  OBJECTIVE
  The aim of this study was to assess the outcome of treatment in patients older than 70 years old.
  
  
  METHODS
  We performed a retrospective chart review of 150 patients aged 70 years and older who were treated at Jefferson Hospital from 2004 to 2009. Data including World Federation of Neurological Surgeons grade and Hunt and Hess classification, specific management components, and treatment outcome on discharge were analyzed.
  
  
  RESULTS
  One hundred ten patients had aneurysms coiled, 9 patients had aneurysms clipped, 11 patients had aneurysms that were not treated, and 20 patients had no visible aneurysms. Overall, increased World Federation of Neurological Surgeons grades correlated strongly with poor clinical outcome. Statistical tests indicate that patients who died (mean, 78.8, n=35) or who went into rehabilitation (mean, 76.5, n=81) were significantly older than patients who were discharged home (mean, 73.1, n=20). However, day of presentation after initial symptom(s) of subarachnoid hemorrhage and placement of ventriculoperitoneal shunt also influenced clinical outcome. Patients who had a ventriculoperitoneal shunt were more likely to go into rehabilitation than patients who did not, and patients without a ventriculoperitoneal shunt were more likely to die.
  
  
  CONCLUSIONS
  Older age should not preclude a patient from aneurysm treatment. Factors such as low Hunt and Hess or World Federation of Neurological Surgeons grades, earlier presentation to the hospital after initial symptoms, early shunting, prompt interventions, and tailored postoperative management can result in favorable clinical outcomes.
authors.affiliation: Jefferson Medical College, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Olatilewa O
authors.initials: OO
authors.lastname: Awe
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.forename: Robert
authors.initials: R
authors.lastname: Rossenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality*; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome