评估长期结果的数据,特别是关于治疗方式,八十岁老人的动脉瘤性蛛网膜下腔出血(SAH)有限。主要目标是评估性情(在家生活与机构环境),并分析SAH后八十岁老人的长期生存和返回家园的预测因素。
从100%全国Medicare住院索赔中提取了80岁及以上接受显微外科手术夹闭或血管内盘绕的SAH患者的数据,并与最低数据集(2008-2011)相关联。在索引性SAH入院后跟踪患者处置2年。按动脉瘤治疗方式分层的多变量逻辑回归,并调整了患者因素,包括SAH严重程度,评估了SAH后60天和365天返回家中的预测因素。使用多变量Cox比例风险模型分析SAH后365天的生存率。
共1298例纳入分析。SAH后一年,56%的病人已经死亡或接受临终关怀,8%的人在机构急性后护理环境中,36%的人已经回家。开放式显微外科手术夹闭(调整后的风险比[aHR]0.67,95%置信区间[CI]0.54-0.81),男性(AHR0.70,95%CI0.57-0.87),气管造口术(AHR0.63,95%CI0.47-0.85),胃造口术(AHR0.60,95%CI0.48-0.76),和更差的SAH严重程度(aHR0.94,95%CI0.92-0.97)与患者回家的可能性降低相关.年龄较大(AHR1.09,95%CI1.05-1.13),气管造口术(aHR2.06,95%CI1.46-2.91),胃造口术(AHR1.55,95%CI1.14-2.10),男性(AHR1.66,95%CI1.20-2.23),SAH严重程度恶化1.51(95%CI1.04-2.18)与生存率降低相关。
在这个国家分析中,56%的八十岁SAH患者死亡,36%的人在SAH后1年内返回家园。线圈栓塞预测回家,这可能表明该患者人群的血管内治疗有益。
Data evaluating the long-term outcomes, particularly with regard to treatment modality, of aneurysmal subarachnoid hemorrhage (SAH) in octogenarians are limited. The primary objectives were to evaluate the disposition (living at home vs institutional settings) and analyze the predictors of long-term survival and return to home for octogenarians after SAH.
Data pertaining to patients age 80 and older who underwent microsurgical clipping or endovascular coiling for SAH were extracted from 100% nationwide Medicare inpatient claims and linked with the Minimum Data Set (2008-2011). Patient disposition was tracked for 2 years after index SAH admission. Multivariable logistic regression stratified by aneurysm treatment modality, and adjusted for patient factors including SAH severity, evaluated predictors of return to home at 60 and 365 days after SAH. Survival 365 days after SAH was analyzed with a multivariable Cox proportional hazards model.
A total of 1298 cases were included in the analysis. One year following SAH, 56% of the patients had died or were in hospice care, 8% were in an institutional post-acute care setting, and 36% had returned home. Open microsurgical clipping (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.54-0.81), male sex (aHR 0.70, 95% CI 0.57-0.87), tracheostomy (aHR 0.63, 95% CI 0.47-0.85), gastrostomy (aHR 0.60, 95% CI 0.48-0.76), and worse SAH severity (aHR 0.94, 95% CI 0.92-0.97) were associated with reduced likelihood of patients ever returning home. Older age (aHR 1.09, 95% CI 1.05-1.13), tracheostomy (aHR 2.06, 95% CI 1.46-2.91), gastrostomy (aHR 1.55, 95% CI 1.14-2.10), male sex (aHR 1.66, 95% CI 1.20-2.23), and worse SAH severity 1.51 (95% CI 1.04-2.18) were associated with reduced survival.
In this national analysis, 56% of octogenarians with SAH died, and 36% returned home within 1 year of SAH. Coil embolization predicted returning to home, which may suggest a benefit to endovascular treatment in this patient population.