IMPACT OF EARLY SURGERY ON OUTCOME AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE - A POPULATION-BASED STUDY

Background and Purpose: Population-based patient materials have not be en used earlier in assessing the effects of neurosurgical treatment on survival and functional outcome of subarachnoid hemorrhage. Moreover, the proportion of all subarachnoid hemorrhage patients who might be c andidates for neurosurgical treatment has not been estimated. Methods: We compared the survival and functional outcome of two population-bas ed patient materials from Central Finland in 1976 through 1978 (n=146) and 1980 through 1987 (n=351). The most important basic characteristi cs of both materials were similar. In the 1970s, only patients aged < 60 years with carotid territory aneurysms were operated on after an in terval of 2 weeks from the bleeding. In the 1980s, early surgery was a ttempted, and the other exclusion criteria were abandoned. Allocation to medical or surgical treatment was not randomized. Results: During t he 1970s, only 14% of the patients had surgical treatment, with a medi an delay of 15 days after the bleeding; in the 1980s, the correspondin g figures were 46% and 4 days. Despite these fundamental changes in th e treatment policy, the survival up to 3 years in the 1980s was only m arginally improved compared with the 1970s. Conversely, the functional outcome at 4 years after the bleeding was significantly better in the 1980s than the 1970s, with 82% and 64% of the survivors, respectively , being independent in the activities of daily living (P=.002). We est imated that 60% of all patients with subarachnoid hemorrhage might be candidates for neurosurgical treatment, provided that there are no del ays in admission or evaluation. Conclusions: An active treatment polic y of subarachnoid hemorrhage including early surgery only marginally i mproves survival, but the quality of life of the survivors is signific antly better. Only 60% of all patients in the population with subarach noid hemorrhage can, at least theoretically, benefit from surgical tre atment.