Background: Management and outcome data on spontaneous subarachnoid hemorrhage (SAH) in Greece are scarce. We analyzed 13-year (2002-2014) retrospective data on all first-ever SAH patients referred to one of the largest neurosurgical academic departments.
Methods: Patient demographic/clinical status, length-of-hospital stay, and hospital outcome were determined. Outcome in different treatment categories was compared and prognostic factors identified.
Results: A total of 719 patients were identified (mean age, 55 ± 12 years; men:women ratio, 1:1.4). Angiography (DSA) was performed in 88% of patients (N = 632); it was positive in 77.5% (N = 490). DSA was not performed in the remaining cases mainly due to early deaths (67 of 87; 77%). Of DSA-positive patients 74.9% (367 of 490; 51% of the total sample) underwent treatment. It comprised predominantly of coiling (81.5%) and to a lesser extent of clipping (18.5%). Lack of treatment on DSA-positive patients was largely due to early deaths (66 of 123; 53.7%). Favorable outcome was recorded in 45.6% overall (328 of 719). Favorable outcome or mean length of hospital stay did not differ significantly between coiling (51.2%; 24.7 ± 49 days) and clipping (48.8%; 28.8 ± 28 days). Nevertheless, the surgery group had a significantly higher proportion of dead patients. Advanced age and poor clinical presentation were independent risk factors for bad outcome.
Conclusions: Predominance of coiling over time is consistent with current trends in Western Europe and the United States. Outcome of clipping or coiling was comparable to previous salient series. Early treatment/centralization of care remain prerequisites for extending treatment options and further improving SAH outcome.
Keywords: Cerebral aneurysms; Greece; Hospital outcome; Length of hospital stay; Management; Prognosis; SAH; Spontaneous subarachnoid hemorrhage.
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