Analysis of Mortality and Morbidity in Subarachnoid Hemorrhage

Chung, Chun Kee; Jung, Jin Myung; Lee, Sun Ho; Han, Dae Hee

Abstract

A series of 531 consecutive cases of subarachnoid hemorrhage(SAH) admitted neurological and neurosurgical departments during past 7 years was reviewed to assess motality, morbidity and its influencing factors. Those factors including age, sex, neurological status, hypertension, vasospasm(angiographic and symptomatic), location of aneurysm, Fisher's SAH grade, operation time, hydrocephalus and multiplicity of aneurysm were evaluated in isolation and in combination. The overall mortality rat4e was 18.1% and operative mortality was 4.3%, 14 cases among 329 surgical cases. The mortality rate of non-operative group was 40.6%. The difference of mortality rate between two groups was mainly due to neurological grade. 1) The main causes of death in operative group were vasospasm(64.3%) and surgical complication(14.3%). Those of non-operative group were rebleeding, vasospasm and initial ictus. 2) In the operative group, influencing factors on the mortality were Hunt and Hess grade at operatiopn, vasospasm, operation time, Hunt and Hess grade on admission and hydrocephalus in the order of importance. In the non-operative group, neurological grade, hydrocephalus, vasospasm and hypertension were important factors. 3) The morbidity rate(poor outcome) of the operative group was 10.0%(33 cases). The main causes of poor outcome were vasospasm(69.7%) and hydrocephalus(24.2%). Influencing factors were Hunt and Hess grade at operation, symptomatic spasm, Fisher's SAH grade, hydrocephalus and hypertension in the order of importance. 4) The symptomatic vasospasm was related to Fisher's SAH grade and Hunt and Hess grade but it was not related to the aneurysmal location, age and hypertension. The vasospasm appeared most commonly in Fisher's grade III and strongly influenced on the outcome.