title: Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  There is no consensus regarding the optimal timing for surgery for poor-grade aneurysmal subarachnoid hemorrhage.
  
  
  OBJECTIVE
  To retrospectively evaluate variation in patient characteristics and outcomes between early and delayed surgery groups.
  
  
  METHODS
  Poor-grade aneurysmal subarachnoid hemorrhage was defined as a World Federation of Neurosurgical Societies grade of IV or V after resuscitation. Early surgery was defined as surgery performed within 72 hours of ictus, and delayed surgery was defined as surgery after 72 hours. Outcomes were assessed by modified Rankin score. The mean time of follow-up was 12.5 ± 3.4 months.
  
  
  RESULTS
  Of the 118 patients included in the study, 80 (68%) underwent early surgery and 38 (32%) underwent delayed surgery. Patients with brain herniation (P < .001) and a lower Fisher grade (P = .02) more often underwent early surgery. Patients in the early group more often underwent decompressive craniectomy (P < .001). Postoperative complications and length of hospital stay did not differ, and outcomes were similar between the 2 groups. Forty (34%) patients had an excellent outcome (modified Rankin score 0-1). Multivariate analysis showed a slight trend toward an excellent outcome in the early surgery group. Younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were independent predictors of an excellent outcome.
  
  
  CONCLUSIONS
  Although patients with brain herniation and a lower Fisher grade were more likely to undergo early surgery, there was a slight trend toward an excellent outcome in the early surgery group. Patients with a younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were more likely to experience an excellent outcome.
authors.affiliation: *Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; ‡Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; §Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.forename: Xianxi
authors.initials: X
authors.lastname: Tan
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Cao
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D061665:Time-to-Treatment / Q000592:standards*; D016896:Treatment Outcome