2024 Volume 29 Issue 1 Pages 55-62
The ‘super‒aging’ population in Japan and elsewhere has posed an increase in the number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated the prognostic factors of aSAH by retrospectively analyzing the cases of the 491 patients with aSAH admitted to our hospital from April 2013 to December 2021, stratified by age. After excluding patients aged ≤ 59 or ≥ 90 years, we divided the remaining 273 patients into three age groups: 60‒69 years (n=92), 70‒79 years (n=97), and 80‒89 years (n=84). The groups’ respective mean ages±SD were 64.5±2.95, 74.4±2.86, and 84.0±2.71 years, with a higher proportion of women in all three groups. Compared to the patients aged 60‒79 years, those in their 80s had significantly lower proportions of pre‒onset modified Rankin Scale (mRS) scores 0 to 2 (p<0.001), World Federation of Neurosurgical Societies (WFNS) grades I‒III (p=0.027), and a prior history of surgery (p=0.031). The 70‒79 age group had significantly higher proportions of hypertension (p<0.001), ischemic heart disease (p=0.041), and use of antithrombotic medications (p=0.018), and they were significantly more likely to undergo coil embolization than a craniotomy (p<0.001); their rates of therapeutic completion (p=0.001) and mRS scores 0‒2 at discharge (p<0.001) were also significantly lower. A univariate analysis of factors for poor prognosis (defined as mRS scores 0‒2) revealed that age ≥ 80 years, WFNS grade IV‒V, presence of cerebral aneurysms, wide neck, and nonoperative cases were significant factors. The multivariate analysis of these factors revealed that ≥ 80 years and WFNS grades IV‒V were independent factors for poor prognosis. Age >80 years may be an important factor in deciding the treatment strategy for aSAH, in Japan and other countries with aging populations.
