Related Experiment Video
Updated: Sep 16, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Clinical Predictors of Inpatient Mortality and Poor Postoperative Course After aSAH Microsurgical Clipping: A 10-Year
Fernando Terry1, Alejandro Enríquez-Marulanda2, Nathaly Chinchihualpa-Paredes3
1Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15101, Peru.
Insights
Severe WFNS scores and postoperative complications significantly increase inpatient mortality risk in aneurysmal subarachnoid hemorrhage (aSAH) patients. Glasgow scores and complications predict a poor postoperative course, highlighting the need for targeted neurocritical care strategies.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Epidemiology
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological emergency with high mortality.
- Urgent treatment is essential for patients with aSAH.
- Identifying predictors of mortality and poor outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify clinical predictors of inpatient mortality following surgical clipping for aSAH.
- To determine factors associated with a poor postoperative course in aSAH patients.
- To inform neurocritical care policies and interventions for aSAH.
Main Methods:
- Retrospective review of 210 aSAH patients treated with surgical clipping (2010-2019).
- Collection of demographic and clinical data.
- Univariate, bivariate, and multivariate Poisson regression analyses were performed.
Main Results:
- Overall inpatient mortality was 11.43%.
- Severe WFNS scale scores and postoperative neurosurgical complications (1 or ≥2) significantly increased inpatient mortality risk.
- Moderate/severe Glasgow scores on admission and postoperative clinical complications (1 or ≥2) were associated with a poor postoperative course.
Conclusions:
- Clinical factors like WFNS and Glasgow scores, along with postoperative complications, are significant predictors of outcomes in aSAH.
- Findings support the need for enhanced neurocritical care and targeted interventions.
- Further multi-centered prospective studies are recommended for validation and policy development, particularly for the Peruvian population.
Abstract:
Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality rate requiring urgent treatment. This study aimed to identify clinical predictors of inpatient mortality and poor postoperative course after aSAH surgical clipping. Methods: We performed a retrospective review of medical records for 210 patients with aSAH treated via surgical clipping at our institution between 2010 and 2019. Baseline demographic data and clinical characteristics related to aSAH were collected. To identify factors associated with inpatient mortality and a poor postoperative course after aSAH microsurgical clipping, we conducted a univariate and bivariate analysis, as well as a multivariate analysis via the Poisson regression model. Results: The overall cumulative mortality over the 10-year study period was 11.43%. A severe WFNS scale score (aRR: 2.86; 95% CI: 1.28-6.39; p = 0.011) and having 1 (aRR: 5.76; 95% CI: 2.02-16.39, p = 0.001) or ≥2 (aRR: 18.86; 95% CI: 5.16-68.90, p < 0.001) postoperative neurosurgical complications were associated with an increased risk of inpatient mortality. A moderate (aRR: 3.71; 95% CI: 1.45-9.50; p = 0.006) or severe (aRR: 4.18; 95% CI: 1.12-15.60; p = 0.034) Glasgow scale score on admission, and presenting 1 (aRR: 2.31; 95% CI: 1.27-4.19; p = 0.006) or ≥2 postoperative clinical complications (aRR: 3.34; 95% CI: 1.83-6.10; p < 0.001) were associated with an increased risk of a poor postoperative course. Conclusions: While promising and widely supported by the published literature, these findings require further validation in a larger prospective and multi-centered study to adequately propose health policies on neurointensive care for the Peruvian population. Ultimately, developing socioeconomic setting-focused intervention algorithms and clinical practice guidelines could enhance the survival and postoperative course of patients presenting with aSAH.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management