To determine the most proper timing of surgery for ruptured aneurysms, the outcome of patients between those who received emergency surgery and those who received early planned surgery was compared.
Between 1990 and 1994, 211 patients were admitted to Saiseikai Kumamoto Hospital within three days after the onset of subarachnoid hemorrhage and operated within two days.
They were classified into 3 groups. Group 0 (42 patients, 19,9%) are those who underwent emergency surgery on admission, group 1 (114 patients, 54.0%) are those who received surgery on the following day of admission and group 2 (55 patients, 26.1%) are those operated on thereafter. Good outcome ratio (good recovery or moderately disabled in Glasgow Outcome Scale) of group 0, 1 and 2 was 71.4%, 87.7% and 74.5%, respectively. The outcome of group 1 was significantly superior to that of group 0 after stratification of preoperative neurological gradings in each group.
On the other hand, five of 183 patients (2.7%) in the planned surgery group had aneurysm rerupture while waiting for surgery and 2 patients died of hemorrhage. The overall outcome was better in group 1 than group 0.
This study suggested that emergency surgery on admission for ruptured aneurysm was not necessarily indispensable and planned surgery on the following day achieved better results than emergency surgery. It is also stressed that the timing of surgery should be determined on the basis of manpower or accommodation capacity in each institution.
