Sabah Rehman1, Ronil V Chandra2,3, Kevin Zhou2, Darius Tan4, Leon Lai3,4, Hamed Asadi2, Jens Froelich5, Nova Thani6, Linda Nichols7, Leigh Blizzard1, Karen Smith8, Amanda G Thrift9, Christine Stirling7, Michele L Callisaya1,10, Monique Breslin1, Mathew J Reeves11, Seana Gall12,13. 1. Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia. 2. NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia. 3. School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. 4. Neurosurgery, Monash Health, Melbourne, Victoria, Australia. 5. NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia. 6. Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia. 7. School of Nursing, University of Tasmania, Hobart, Tasmania, Australia. 8. Ambulance Victoria, Victoria, Australia. 9. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. 10. Monash University, Melbourne, Victoria, Australia. 11. Department of Epidemiology, Michigan State University, East Lansing, MI, USA. 12. Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia. Seana.Gall@utas.edu.au. 13. Monash University, Melbourne, Victoria, Australia. Seana.Gall@utas.edu.au.
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.
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.
Entities:
Keywords:
Aneurysm; Sex characteristics; Subarachnoid haemorrhage
Authors: Hadie Adams; Vin Shen Ban; Ville Leinonen; Salah G Aoun; Jukka Huttunen; Taavi Saavalainen; Antti Lindgren; Juhana Frosen; Mikael Fraunberg; Timo Koivisto; Juha Hernesniemi; Babu G Welch; Juha E Jaaskelainen; Terhi J Huttunen Journal: Stroke Date: 2016-09-15 Impact factor: 7.914
Authors: Gian Marco De Marchis; Chris Schaad; Christian Fung; Juergen Beck; Jan Gralla; Jukka Takala; Stephan M Jakob Journal: Clin Neurol Neurosurg Date: 2017-04-06 Impact factor: 1.876