Abstract
Background: Retrieving elderly (≧75 y) patients with subarachnoid hemorrhage (SAH) from frailty is very important. We established a systematic protocol for achieving this purpose: coiling under local anesthesia, acute phase radical aneurysm treatment, prohibition of prophylactic cerebrospinal fluid drainage, and ambulation from the next day after a surgery. We reviewed our treatment outcomes.
Methods: From January 2005 to April 2016, 85 patients (11 male and 74 female) who underwent radical aneurysm treatment (28 coiling and 57 clipping) of 116 consecutive patients with SAH were analyzed. Patients with preoperative modified Rankin scale (m-RS) scores 1-3 and Hunt-Kosnik (HK) grades 1-3 were candidates for radical aneurysm treatment. Treatment methods (coiling or clipping) were decided after discussions with a certificated neurosurgeon and interventional surgeon. We defined m-RS 0-2 as independent state. In follow-ups of one month and longer (>3 months) after the onset of SAH, m-RS scores were determined. Statistical analysis was performed to distinguish factors that influence independent living.
Results: The median age was 78 years (range 75-89), and HK grades 1-3 were observed in 83%. Ratios of premorbid conditions or posterior circulation aneurysms were significantly larger in the coiling group; ratios of early ambulation or middle cerebral artery aneurysms were significantly larger in the clipping group. Independent state 1 month after the SAH was observed in 39% in the coiling group and in 35% in the clipping group; at 3 months, independent state was observed in 46% in the coiling group and in 35% in the clipping group. Multivariate analysis for independent state revealed the absence of pre-morbid condition, early ambulation, and absence of postoperative complications in the coiling group, and HK grade, early ambulation, and the absence of postoperative complications in the clipping group.
Conclusions: Our protocol is useful and effective. In elderly patients with SAH, early ambulation and avoiding postoperative complications after radical aneurysm treatment positively influence retrieval from frailty.
