Aneurysmal Subarachnoid Hemorrhage; Early Surgery; Neurosurgeons Experience; Patient Outcome

Abstract

BACKGROUND: This study examined the impact of neurosurgeons' experience on surgical timing and outcomes in aneurysmal subarachnoid hemorrhage (aSAH) and questioned the adherence to early surgery as recommended by recent guidelines. METHODS: A retrospective analysis of 196 aSAH patients treated between 2013 and 2020 was conducted. Variables included age, sex, initial Glasgow Coma Scale (GCS) scores, World Federation of Neurological Surgeons grades, Fisher's grades, rebleeding, hydrocephalus, and preoperative-postoperative neurological status. Neurosurgeons' experience was categorized by the number of surgeries performed: >200 (group 1), 101-200 (group 2), and <100 (group 3). Outcomes measured were postoperative neurological deterioration (post-ND), 6-month modified Rankin Scale score, and mortality. Statistical analysis included Pearson's X-2 test, t-test, analysis of variance, and logistic regression, with significance set at P < 0.05. RESULTS: Of the patients, 50.5% were female, with an average age of 55.1 +/- 13.2 years. Early surgery was associated with lower GCS scores and lower surgical experience (GCS odds ratio [OR] 1.405, P = 0.025; experience OR 19.199, P < 0.001). Post-ND rates were 13%, 36.1%, and 21.2% in groups 1, 2, and 3, respectively (P = 0.007). Mortality-related factors included rebleeding (OR 2.625, P = 0.033), neurological deterioration (OR 3.443, P = 0.004), and hydrocephalus (OR 3.408, P = 0.02). Outcomes of Group 1 were found to be superior to the other 2 groups in terms of post-ND (P = 0.007) and hydrocephalus (P = 0.044). CONCLUSIONS: Experienced neurosurgeons tend to favor delayed intervention for aSAH surgery. While experience positively influences early outcomes, its impact on long-term results is less significant. Future studies could lead to improvements in neurosurgical practices.