Abstract Details

Title Outcomes of Subarachnoid Hemorrhage Patients Treated in a Hospital without Vascular Neurosurgery Compares Well with Literature

Topic Interventional Neurology

Presentation(s) S46 - (-)

Poster/Presentation
Number 007

Objective

Background Guidelines recommend spontaneous subarachnoid hemorrhage (sSAH) patients be cared for in centers with vascular neurosurgeons (VNS), vascular neurologists, neurointerventionalists, and neurocritical care We sought to evaluate our outcomes for sSAH patients in a hospital with all components except a fellowship trained VNS, and compare these with known morbidity and mortality rates of 40-50%.

Design/Methods Get With the Guidelines database and medical records were reviewed to extract all sSAH patients admitted from 8/1/2006-10/31/2011 and identify admission Hunt and Hess (HH) grades, treatment type, comorbidities, and 6 month modified Rankin scales (mRS).

Results A total of 90 patients presented with sSAH. HH grades of these patients were as follows: I-II, n=32 (36%); III, n=33(37%); IV-V, n=25 (28%). Endovascular treatment was performed in 36 (40%), surgical clipping in 6 (7%), 10 patients (11%) were in extremis and treatment was deferred (all subsequently expired), while 38 (42%) had negative angiography. All with negative angiography underwent a second angiogram as well as brain/cervical magnetic resonance imaging. Hydrocephalus requiring ventriculostomy occurred in 39 (43%); 7 patients (8% of 90) had symptomatic vasospasm requiring endovascular treatment; 3 (3%) had treatment complications. Among the 42 patients who had repair procedures, 11 died in the hospital from any cause (26%). For the total cohort, mRS at 6 months were: 0, n=30 (33%); 1, n=9, (10%); 2, n=5 (6%); 3, n=3 (3%); 4, n=1 (1%); 5, n= 3 (3%), 6, n=21 (23%); lost to follow up, n=17 (19%).

Conclusions Our data show that care of sSAH patients in a hospital with all recommended components except on-site VNS yields outcomes on par with literature. Limit sSAH patient care to hospitals with an on-site VNS may decrease availability of health services to the public, with little added benefit.

Authors/Disclosures
Benedict Tan, MD (Valley Regional Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
Nazli A. Janjua, MD, MBBS	Dr. Janjua has nothing to disclose.
	No disclosure on file

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