Clinical Predictors of Inpatient Mortality and Poor Postoperative Course After aSAH Microsurgical Clipping: A 10-Year Experience from a Peruvian Tertiary Care Center

TL;DR

This study identifies clinical factors that predict inpatient mortality and poor recovery after surgery for aSAH in a Peruvian hospital over 10 years.

Contribution

The study provides region-specific predictors of mortality and recovery outcomes for aSAH patients in a developing country setting.

Findings

Severe WFNS scale scores and postoperative complications significantly increase inpatient mortality risk.

Moderate or severe Glasgow scores and postoperative complications are linked to a poor postoperative course.

The study highlights the need for region-focused guidelines to improve outcomes for aSAH patients in developing countries.

Abstract

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality rate requiring urgent treatment. This study aimed to identify clinical predictors of inpatient mortality and poor postoperative course after aSAH surgical clipping. Methods: We performed a retrospective review of medical records for 210 patients with aSAH treated via surgical clipping at our institution between 2010 and 2019. Baseline demographic data and clinical characteristics related to aSAH were collected. To identify factors associated with inpatient mortality and a poor postoperative course after aSAH microsurgical clipping, we conducted a univariate and bivariate analysis, as well as a multivariate analysis via the Poisson regression model. Results: The overall cumulative mortality over the 10-year study period was 11.43%. A severe WFNS scale score (aRR: 2.86; 95% CI: 1.28–6.39; p = 0.011) and having 1 (aRR: 5.76; 95% CI: 2.02–16.39, p = 0.001) or ≥2 (aRR: 18.86; 95% CI: 5.16–68.90, p < 0.001) postoperative neurosurgical complications were associated with an increased risk of inpatient mortality. A moderate (aRR: 3.71; 95% CI: 1.45–9.50; p = 0.006) or severe (aRR: 4.18; 95% CI: 1.12–15.60; p = 0.034) Glasgow scale score on admission, and presenting 1 (aRR: 2.31; 95% CI: 1.27–4.19; p = 0.006) or ≥2 postoperative clinical complications (aRR: 3.34; 95% CI: 1.83–6.10; p < 0.001) were associated with an increased risk of a poor postoperative course. Conclusions: While promising and widely supported by the published literature, these findings require further validation in a larger prospective and multi-centered study to adequately propose health policies on neurointensive care for the Peruvian population. Ultimately, developing socioeconomic setting-focused intervention algorithms and clinical practice guidelines could enhance the survival and postoperative course of patients presenting with aSAH.

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