Management of Aneurysmal Subarachnoid Hemorrhage - Variation in Clinical Practice and Unmet Need for Follow-up among Survivors - A Single Center Perspective.

Purpose of the present study is to investigate the existence and/or prevalence of clinical practice variation in management of aneurysmal subarachnoid hemorrhage (aSAH) and to determine need for long-term follow-up.Single-center study of aSAH patients over a 5-year period divided into two halves (2.5 years each) before and after addition of a dually trained cerebrovascular neurosurgeon. In-hospital clinical practice, clinical outcome (mortality, discharge destination) and long-term outcome (modified Rankin scale, mRS and telephone interview for cognitive status, TICS) were compared using descriptive summaries and non-parametric tests.Among 251 aSAH patients admitted, 115 (45.8%) were prior to the index event, while 136 (54.2%) were during the later period. The aneurysm securing procedure changed from coil embolization to clip ligation [12/115 (10.4%) vs. 84/136 (61.8%), p<0.0001] during the latter years. Interventional treatment for cerebral vasospasm has decreased [58/115 (50.4%) vs. 49/136 (36.0%), p=0.0002]. Patients surviving hospitalization had more clinic follow-up post-discharge during the latter period [42/85 (49.4%) vs. 76/105 (72.4%), p=0.0012] and ventriculoperitoneal shunt placement for delayed hydrocephalus [1/85 (1.2%) vs. 9/105 (8.6%), p=0.02]. A sub-cohort (n=46) of aSAH survivors had lower median TICS score during the earlier study period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, pre-ictal smoking status and hyperlipidemia were associated with adverse TICS score in a multivariate model (p=0.007).Post-discharge clinic follow-up has improved facilitating recognition and treatment of delayed hydrocephalus. Existence of cognitive deficits among survivors call for establishment of multidisciplinary clinics for long-term aSAH management.