Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: High-quality evidence comparing surgical strategies within 0-24 h and 24-72 h after aneurysmal subarachnoid hemorrhage (aSAH) remains limited. This study aimed to systematically evaluate surgical safety and long-term outcomes across these two critical time windows. METHODS: Patients with aSAH undergoing aneurysm surgery within 72 h were consecutively enrolled from 12 tertiary centers in northern China between January 2017 and December 2020. A 1:1 propensity score matching (PSM) adjusted for intergroup differences, and a generalized estimating equation (GEE) model accounted for hospital-level clustering. Outcomes were compared between the 0-24 h and 24-72 h groups. Kaplan-Meier curves assessed survival, Cox models identified mortality risk factors, and logistic regression determined predictors of 2-year dependency. RESULTS: A total of 3560 patients were included. After PSM, 1329 patients in the 0-24 h group were matched with 1329 in the 24-72 h group. There were no significant differences in 2-year mortality (12.3% vs 10.8%, p = 0.49), dependency at discharge (21.0% vs 18.4%; adjusted odds ratio (OR) = 0.815, 95% confidence interval (CI) = 0.649-1.024, p = 0.079), or 2-year dependency (10.6% vs 9.3%; adjusted OR = 0.896, 95% CI = 0.636-1.264, p = 0.533). Compared with the 0-24 h group, the 24-72 h group had lower in-hospital mortality (3.8% vs 1.1%; adjusted OR = 0.503, 95% CI = 0.349-0.723, p < 0.001), rebleeding (3.6% vs 1.9%; adjusted OR = 0.489, 95% CI = 0.299-0.801, p = 0.004), and stress ulcer bleeding (8.7% vs 4.9%; adjusted OR = 0.811, 95% CI = 0.713-0.922, p = 0.001). Risk factors for mortality and 2-year dependency differed between groups. CONCLUSION: Surgery within 24 h of onset showed similar long-term outcomes compared with treatment at 24-72 h, but in-hospital mortality and some hemorrhage-related complications differed. Risk factor analysis may provide guidance for individualized treatment strategies.
Source: International Journal of Stroke
Institutions: Tianjin Medical University General Hospital, Tianjin Medical University, Affiliated Hospital of Qingdao University, First Affiliated Hospital of Bengbu Medical College, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, Nanjing Drum Tower Hospital, Nanjing University, The Affiliated Yongchuan Hospital of Chongqing Medical University, Linyi People's Hospital
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7129754859