Management of Aneurysmal Subarachnoid Hemorrhage: Variation in Clinical Practice and Unmet Need for Follow-up among Survivors–A Single-Center Perspective

Claire Delpirou Nouh, Danny G. Samkutty, Swathy Chandrashekhar, Joshua A. Santucci, Lance Ford, Chao Xu, Kimberly M. Hollabaugh, Bradley N. Bohnstedt, Bappaditya Ray

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of the present study is to investigate the existence and/or prevalence of clinical practice variation in management of aneurysmal subarachnoid hemorrhage (aSAH) and to determine the need for long-term follow-up. Methods: A single-center study was carried out of patients with aSAH over a 5-year period divided into 2 halves (2.5 years each) before and after addition of a dually trained cerebrovascular neurosurgeon. In-hospital clinical practice, clinical outcome (mortality and discharge destination) and long-term outcome (modified Rankin Scale score and Telephone Interview for Cognitive Status [TICS]) were compared using descriptive summaries and nonparametric tests. Results: Among 251 patients admitted with aSAH, 115 (45.8%) were before the index event, whereas 136 (54.2%) were during the later period. The aneurysm-securing procedure changed from coil embolization to clip ligation (12/115 [10.4%] vs. 84/136 [61.8%]; P < 0.0001) during the latter years. Interventional treatment for cerebral vasospasm has decreased (58/115 [50.4%] vs. 49/136 [36.0%]; P = 0.0002). Patients surviving hospitalization had more clinic follow-up after discharge during the latter period (42/85 [49.4%] vs. 76/105 [72.4%]; P = 0.0012) and ventriculoperitoneal shunt placement for delayed hydrocephalus (1/85 [1.2%] vs. 9/105 [8.6%]; P = 0.02). A subcohort of aSAH survivors (n = 46) had lower median TICS score during the earlier study period (31.5 [interquartile range, 22–36] vs. 33 [interquartile range, 27–38]; P = 0.038). Similarly, preictal smoking status and hyperlipidemia were associated with adverse TICS score in a multivariate model (P = 0.007). Conclusions: Postdischarge clinical follow-up has improved facilitating recognition and treatment of delayed hydrocephalus. Existence of cognitive deficits among survivors calls for establishment of multidisciplinary clinics for long-term management of aSAH.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Cognitive outcome
  • Practice patterns
  • Subarachnoid hemorrhage
  • Systems of care

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Delpirou Nouh, C., Samkutty, D. G., Chandrashekhar, S., Santucci, J. A., Ford, L., Xu, C., Hollabaugh, K. M., Bohnstedt, B. N., & Ray, B. (Accepted/In press). Management of Aneurysmal Subarachnoid Hemorrhage: Variation in Clinical Practice and Unmet Need for Follow-up among Survivors–A Single-Center Perspective. World neurosurgery. https://doi.org/10.1016/j.wneu.2020.04.067