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


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, Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome, Acta Neurochirurgica pp. 1-12. ISSN 0001-6268 (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Springer-Verlag GmbH Austria, part of Springer Nature

DOI: doi:10.1007/s00701-020-04469-5


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 < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders.

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 Details

Item Type:Refereed Article
Keywords:sex differences, aSAH, aneurysm, sex characteristics, subarachnoid haemorrhage
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Central nervous system
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Rehman, S (Dr Sabah Rehman)
UTAS Author:Nichols, L (Mrs Linda Nichols)
UTAS Author:Blizzard, L (Professor Leigh Blizzard)
UTAS Author:Stirling, C (Professor Christine Stirling)
UTAS Author:Callisaya, ML (Dr Michele Callisaya)
UTAS Author:Breslin, M (Dr Monique Breslin)
UTAS Author:Gall, S (Associate Professor Seana Gall)
ID Code:139971
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-07-21
Last Modified:2020-08-04

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