Health-related quality of life in patients who had been in Hunt and Hess grades IV or V on admission to the neurosurgical unit

Abstract

Next to a substantial reduction of mortality and morbidity, the progress that has modified neurosurgical treatment of ruptured intracranial aneurysms considerably in the last years has led to increasingly frequent surgery on patients in Hunt and Hess grades IV or V on admission to the neurosurgical unit. In some centers, it is attempted to attain an exclusion of the ruptured aneurysm by early surgery in all patients in a Hunt and Hess grade IV or V with only few exceptions (Hütter et al., 1998; LeRoux et al., 1996b; Spetzger and Gilsbach, 1994; Seifert, Trost and Stolke, 1990; Bailes et al., 1990; Gilsbach et al., 1989; 1988b; Brandt et al, 1987). On the basis of the poor prognosis in this group of SAH patients the question arises in how far and under what conditions the patients surviving after maximal medical therapy show an acceptable quality of life in their later everyday life. Therefore, verification of the prognostic relevance of a number of clinical variables is important for the later quality of life. For this reason, at the Department of Neurosurgery of the University Hospital of the University of Technology (RWTH) Aachen, a prospective study was conducted with the intent to contribute to the clarification of the open questions associated herewith. A consecutive series of 192 patients who had been operated upon a ruptured aneurysm between 1990 and June 1992 in the Departments of Neurosurgery of the RWTH Aachen were investigated with regard to their HRQOL 2-3 years after the acute event using the ALQI (Hiitter and Gilsbach, 1996b; 1995b). Of these 39 (20.3%) patients had been in a clinical state grade IV or V after Hunt and Hess on admission to the unit, whereas 153 were in a clinical state grade I—III according to Hunt and Hess. In the group of patients with grades IV or V, 33 (84.6%) patients were operated upon early (within 72 hours). In the Hunt and Hess group IV or V, 12 (30.7) died during the acute stage of their illness while a further 5 (12.8%) had died until follow-up two to three years after discharge. In the patient group in a more favorable clinical state on admission to the unit, six (3.9) died during the acute stage of their illness while a further 10 (6.5) patients had died until follow-up.