Abstract
Objective: Japan has the largest elderly population in the world. As data on the clinical outcomes
in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH), including those
older than 80 years, are lacking, we analyzed the characteristics of 54,805 aSAH patients
and recorded their treatments and clinical outcomes using a Japanese nationwide inpatient
database. Methods: Using the Japanese Diagnostic Procedure Combination database, we identified aSAH
patients aged 18 years or older who were hospitalized between July 1, 2010 and March
31, 2016. They were categorized as less than or equal to 60-, 61-70-, 71-80-, 81-90-,
and greater than or equal to 91 years of age. The primary outcome was the modified
Rankin Scale (mRS) score at discharge. Multivariable logistic regression analysis
was performed to examine factors affecting the mRS score at discharge. Results: Of 54,805 patients, 37.5% were aged less than or equal to 60 years; 24.8% were 61-70-,
21.8% were 71-80-, 13.9% were 81-90-, and 2.0% were greater than or equal to 91 years
old at the time of the insult. Among 46,107 patients younger than 81 years, 58.9%
underwent surgical clipping (SC), 22.9% endovascular coiling (EC), and 18.2% were
treated conservatively. There were 8,698 patients aged 81 years or older, 32.4% underwent
SC, 23.2% EC, and 44.4% were treated conservatively. A poor mRS score (3-6) at discharge
was recorded in 87.2% of patients older than 80 years. Multivariable logistic regression
was used to compare their estimated odds ratio (OR) for a poor mRS score at discharge
with that of patients aged less than or equal to 60 years. The OR increased by 87%
in patients between 61 and 70 years of age (P < .001; OR, 1.87; 95% confidence interval (CI), 1.77-1.98), by 358% in patients aged
from 71 to 80 years (P < .001; OR, 4.58; 95%CI, 4.29-4.89), by 1,035% in patients between 81 and 90 years
(P < .001; OR, 11.35; 95%CI, 10.32-12.49), and by 1,710% in patients aged more than
or equal to 91 years (P < .001; OR, 18.10; 95%CI, 13.96-23.46). Conclusions: As the treatment outcomes in elderly aSAH patients, especially those 80 years old
or older, were poor, the appropriate therapy decisions must be made on a case-by-case
basis.
Key Words
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Article info
Publication history
Published online: March 25, 2020
Accepted:
February 26,
2020
Received in revised form:
February 10,
2020
Received:
December 6,
2019
Footnotes
Disclosures: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Funding: This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141). Drs Yasunaga and Fushimi received grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-00) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104795
Copyright
© 2020 Elsevier Inc. All rights reserved.
