Early Ambulation Produces Favorable Outcome and Nondemential State in Aneurysmal Subarachnoid Hemorrhage Patients Older than 70 Years of Age

Background

We analyzed consecutive subarachnoid hemorrhage (SAH) cases in patients older than 70 years of age who underwent aneurysm surgery. We report the influence of early ambulation on outcome in advanced-age SAH.

Methods

From 2005 through 2010, 71 aneurysmal SAH cases whose Hunt-Hess grades ranged from 1 to 3 were included. All cases underwent clip ligation or coil embolization. Male to female ratio was 8/63; median age was 76 years (range, 70–87). We routinely have patients become ambulatory the day after surgery. The ambulation date was used to determine four groupings: 0–5 days, 6–10 days, 11–15 days, and 16 days and longer. We analyzed the relationship between ambulation date and the Glasgow Outcome Scale (GOS) or dementia at 30 days after the SAH. Favorable outcome was defined as good recovery and moderate disability according to the GOS. Dementia was screened by use of the revised-Hasegawa dementia scale. The chi-square test was used and a P < 0.05 was considered statistically significant.

Results

Mean days to ambulation was 10.7 ± 9.3 SD days. Forty-eight cases (66%) achieved favorable outcome, and 27 cases (38%) reached a nondemential state. Early ambulation positively correlated with favorable GOS and postoperative nondemential state.

Conclusions

Elderly SAH patients with good Hunt-Hess grades should have a clip ligation or endovascular coiling. Early ambulation produces favorable outcome and a nondemential state in elderly SAH patients.

Introduction

The number of elderly patients with subarachnoid hemorrhage (SAH) has been increasing in our society, which also is progressively advancing in age. However, outcomes for elderly SAH patients treated by clipping or coiling are poor because the initial SAH grade is poor, the brain is vulnerable, a high rate of vasospasm exists, and there are diseases of other organs present 1, 2, 4, 18, 19, 24, 25, 27. Many authors have reported that the prognostic factors for poor outcome are age and poor clinical status at admission 2, 3, 4, 8, 10, 18, 22, 24. However, interventions are not able to influence these factors and, in elderly patients, there are many pitfalls to treatment and high levels of disability caused by intensive care along with heart failure, respiratory distress, and diseases of other organs. Patients are forced to rest in bed for long periods, but bed rest induces muscle atrophy that decreases their abilities to perform in daily life and their cognitive function. In 1957, Rankin reported that important factors correlating with outcome in older patients with stroke were prolonged bed rest and lack of exercise (23). In our survey of the literature, we found no paper describing the relationship between ambulation and clinical outcome related to SAH. For safe ambulation, clip ligation or coil embolization of a ruptured aneurysm is necessary. We focused on good-grade, elderly SAH cases to investigate the effect of early ambulation, and we report on the optimal treatment strategy for elderly patients with SAH.