J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A003
DOI: 10.1055/s-0035-1564496

Incidence, Therapy, and Outcome of Aneurysmal Subarachnoid Hemorrhage. The Swiss Study on Aneurysmal Subarachnoid Hemorrhage (Swiss SOS)

B. Schatlo 1, 2, 3, C. Fung 4, M. Stienen 1, 5, A. R. Fathi 2, J. Fandino 2, N. R. Smoll 6, S. Tok 7, R. T. Daniel 8, D. Zumofen 9, J. K. Burkhard 7, H. Dan-Ura 2, M. Röthlisberger 9, M. Reinert 10, K. Winkler 7, P. Ahlborn 5, V. Mendes-Pereira 1, D. D́Alonzo 2, M. Seule 7, H. Kerkeni 2, D. Bervini 8, M. Sailer 9, D. E. Kuhlen 10, L. Remonda 2, V. Rohde 3, K. Mostaguir 1, S. Marbacher 2, D. Valsecchi 10, M. Corniola 1, D. Schöni 2, C. Woernle 7, L. Regli 7, M. Levivier 8, G. Hildebrandt 5, L. Mariani 9, J. Beck 2, R. Guzman 9, A. Raabe 2, P. Bijlenga 1, E. Keller 7, K. Schaller 1
  • 1Neurosurgery, University Hospital, Geneva, Switzerland
  • 2Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • 3Neurosurgery, Georg-August-Universität Göttingen, UMG, Göttingen, Germany
  • 4Neurosurgery, Inselspital Bern, Bern, Switzerland
  • 5Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
  • 6School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
  • 7Neurosurgery, Neurointensive Care, Unispital Zürich, Zürich, Switzerland
  • 8Neurosurgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
  • 9Neurosurgery, Unispital Basel, Basel, Switzerland
  • 10Neurosurgery, Ospedale Civico, Lugano, Switzerland

Aims: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for a large proportion of productive life years lost to stroke. Its management requires a multidisciplinary effort. Much of the presently available data on incidence, treatment, and outcomes come from studies with a strong selection bias, studies confounding all kinds of SAH, that is, aneurysmal and nonaneurysmal, and cohorts of single centers or retrospective series. The aim of this study is to assess incidence, treatment modalities, and outcomes after SAH from a national registry. Methods: Patients admitted with aSAH across Switzerland are included starting January 1, 2009. All eight Swiss hospitals providing neurovascular care for aSAH patients participated in the registry. Admission parameters, treatment, and outcomes at discharge and one year were recorded. Incidence was calculated after WHO standardization and age stratification, and was based on population data from the Swiss Federal Bureau of Statistics. Results: From 2009 to 2013, 1,580 patients were recorded in the Swiss SOS database. The annual incidence of aSAH in the observation period ranged at ∼2.61/100,000/year. Its peak of 7.6/100,000/year was reached in the age group 55 to 59 years. Eighty-six percent of patients arrived at a tertiary neurovascular care center on the same or within one day of symptom occurrence. The ratio of female to male patients was 2:1. Median age at aSAH was 55 years. Good grade aSAH (World Federation of Neurosurgical Societies [WFNS] grades 1 and 2) accounted for more than 38 and 18% of cases, respectively. WFNS grades 3, 4, and 5 made up 7, 10, and 26%, respectively. Fisher grades 1 and 2 accounted for 14% of cases, while 86% were Fisher grades 3 and 4. Surgical aneurysm occlusion was performed in 36% and endovascular occlusion in 48% of cases. After a mean length of stay of 20 days, 51% of patients were discharged with good outcome (mRS <3) and 30% with poor outcome (mRS 3–5). In-hospital mortality was 19%. At one year, good outcome ranged at 68%. Conclusions: The Swiss SOS laid the foundation for a multidisciplinary self-assessment and scientific research by highly specialized health care providers in this complex and costly disease. As previously found for ischemic cerebrovascular disease, the incidence of aSAH in Switzerland ranges at the lower end of the international spectrum with ∼3.5 to 4.0/100,000/year. The results of this first national outcomes database on aSAH reflect a high level of care. Admission rates at a special request.