“July Effect” on Care for Aneurysmal Subarachnoid Hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) following a ruptured intracranial aneurysm accounts for about 5% of strokes, with an incidence of 10.5 per 100,000 person years (about 27,000 patients per year). Outcome after aneurysmal SAH depends on several factors, including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm exclusion from the cerebral circulation.The overall mortality rates range from 32% to 67% with 10%–20% of patients with long-term dependence due to brain damage. In this regard, 12% of patients die before medical treatment can be given and 25% die within the first 24 hours. A further 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one third remain dependent.4 Accordingly, only a small minority of all patients with SAH has a good outcome. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques,5 as well as preoperative and postoperative management of patients, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory. The primary goal of treatment is to exclude the aneurysm sac from the intracranial circulation while preserving the parent artery.