title: Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach.
abstract: The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. karsten.schoeller@neuro.med.uni-giessen.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Schöller
authors.forename: Maike
authors.initials: M
authors.lastname: Massmann
authors.forename: Gertraud
authors.initials: G
authors.lastname: Markl
authors.forename: Mathias
authors.initials: M
authors.lastname: Kunz
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
authors.forename: Hartmut
authors.initials: H
authors.lastname: Brückmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: Jörg-Christian
authors.initials: JC
authors.lastname: Tonn
authors.forename: Christian
authors.initials: C
authors.lastname: Schichor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005853:Geriatrics; D023261:Glasgow Outcome Scale; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome