Abstract
Background
Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes.
Methods
In a retrospective cohort (2010–2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders.
Results
Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90–1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76–1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87–1.48; death RRR 0.75 95% CI 0.51–1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69–1.11; death RRR 0.80 95% CI 0.52–1.23). Results were consistent in propensity score matched models.
Conclusion
The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.
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Acknowledgements
We gratefully thank Gemma Kitsos for creating the database and managing the project, Sue Mosley for data collection in Victoria, and Chao Zhu for statistical help (PhD candidate).
Funding
REDDISH (REducing Delays In aneurysmal Subarachnoid Hemorrhage) was funded by the National Health and Medical Research Council of Australia (NHMRC APP1143155).
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S. Rehman acquired, analysed and interpreted data, drafted the manuscript; R.V. Chandra, K. Smith, N. Thani designed the study, acquired and interpreted data, provided critical intellectual content to draft; K. Zhou and D. Tan acquired and interpreted data, provided critical intellectual content to draft; L. Lai, H. Asadi, M. Reeves, M. Breslin, M. Callisaya interpreted data and provided critical intellectual content to draft; A. Thrift, J. Froelich, L. Nichols, S Gall, L Blizzard and C Stirling designed the study, interpreted data, provided critical intellectual content to draft. All authors approve the final version of the manuscript.
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This study was approved by the Human Research Ethics Committee in Victoria (RES-18-0000-036A) and Tasmania (H0014563). For this retrospective study formal consent is not required.
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This article is part of the Topical Collection on [Sex Differences in Aneurysmal Subarachnoid Hemorrhage (aSAH): Aneurysm characteristics, Neurological complications, and Outcome]
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Rehman, S., Chandra, R.V., Zhou, K. et al. Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome. Acta Neurochir 162, 2271–2282 (2020). https://doi.org/10.1007/s00701-020-04469-5
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DOI: https://doi.org/10.1007/s00701-020-04469-5