Abstract
Background Discharge to rehabilitation is reported in large studies as one important outcome
parameter based on hospital codes. Because neurologic outcome scores (e.g., the modified
Rankin Scale [mRS]) are missing in International Classification of Diseases (ICD)
databases, rehabilitation indirectly serves as a kind of surrogate parameter for overall
outcome. Reported fractions of patients with rehabilitation, however, largely differ
between studies and seem high for patients with aneurysm clipping. Variances in rehabilitation
fractions seem to largely differ between treatments (clipping versus coiling) for
unruptured intracranial aneurysms, so we analyzed our patients for percentage of and
potential factors predicting rehabilitation.
Patients From July 2007 to September 2013, 100 consecutive patients with at least one cerebral
aneurysm underwent aneurysm clipping. Aneurysms were classified as incidental, associated,
pretreated (coil compaction after subarachnoid hemorrhage), and symptomatic (oculomotor
nerve compression, microemboli), and they were assigned to their anatomical location.
Complications (infection, hemorrhage, cerebrospinal fluid fistula, transient and permanent
neurologic deficit, reoperation) and outcome (mRS at 6 months; clip occlusion rate
by postoperative digital subtraction angiography) as well as frequency and type of
rehabilitation were analyzed and correlated retrospectively. Multiple aneurysms clipped
in one procedure were not counted separately regarding complications or outcome (i.e.,
one patient, one outcome).
Results The overall complication rate was 17% including 10% early and 3% permanent neurologic
deficits and 7% reoperations. There were no deaths. Overall, 98% of patients had a
good outcome (mRS 0–2). Clip occlusion rate was 97.9%. Multivariate logistic regression
analysis identified aneurysm location as the only significant independent factor for
risk of complication (p < 0.001) and complication as the only significant independent risk factor for rehabilitation
(p = 0.003). Rehabilitation was indicated or requested by the patient as early neurologic
rehabilitation (5%), inpatient follow-up (15%), and outpatient follow-up (15%). The
long-term care rate was 2%.
Conclusion Microsurgery of unruptured and not acutely ruptured aneurysms (including post-coil
and associated aneurysms) has a low rate of rehabilitation with a low risk of a permanent
neurologic deficit, long-term care, or early neurologic rehabilitation. The rate of
rehabilitation is well below reported risks from studies based on ICD-based health
care analysis. Rehabilitation per se is not a good indicator for outcome.
Keywords
aneurysm - cerebral - rehabilitation - long-term care
