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Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome

Rehman, S, Chandra, RV, Zhou, K, Tan, D, Lai, L, Asadi, H, Froelich, J, Thani, N, Nichols, L ORCID: 0000-0003-3711-993X, Blizzard, L ORCID: 0000-0002-9541-6943, Smith, K, Thrift, AG, Stirling, C ORCID: 0000-0003-2723-8302, Callisaya, ML ORCID: 0000-0003-2122-1622, Breslin, M ORCID: 0000-0002-8135-3136, Reeves, MJ and Gall, S ORCID: 0000-0002-5138-2526 2020 , 'Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome' , Acta Neurochirurgica , pp. 1-12 , doi: 10.1007/s00701-020-04469-5.

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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 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.

Item Type: Article
Authors/Creators:Rehman, S and Chandra, RV and Zhou, K and Tan, D and Lai, L and Asadi, H and Froelich, J and Thani, N and Nichols, L and Blizzard, L and Smith, K and Thrift, AG and Stirling, C and Callisaya, ML and Breslin, M and Reeves, MJ and Gall, S
Keywords: sex differences, aSAH, aneurysm, sex characteristics, subarachnoid haemorrhage
Journal or Publication Title: Acta Neurochirurgica
Publisher: Springer-Verlag Wien
ISSN: 0001-6268
DOI / ID Number: 10.1007/s00701-020-04469-5
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Copyright 2020 Springer-Verlag GmbH Austria, part of Springer Nature

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