American Society of Anesthesiology Physical Status Classification Is a Novel Predictor of Outcomes in Surgically Treated Aneurysmal Subarachnoid Hemorrhage

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke marked by high morbidity and mortality. Treatment strategies involve endovascular techniques or neurosurgical clipping, and identifying predictors of outcomes can help guide management. We examined an institutional cohort of aSAH patients who underwent surgical or endovascular treatment to describe clinical course and to identify practical, routinely available clinical factors associated with outcomes and with select complications.

Methods: We retrospectively identified all patients with treated aSAH between January 1, 2017, and December 31, 2019, at our institution. Functional status at discharge was assessed with the modified Rankin Scale.

Results: We included 129 consecutive patients in this study, 103 (79.8%) of whom received endovascular treatment, while 25 (19.4%) were treated with clipping and 1 patient (0.8%) was treated with both. Factors associated with vasospasm in multivariable analysis were higher Hunt-Hess grade and aneurysm clipping. Independent predictors of favorable functional status were age, absence of preoperative altered mental status, and American Society of Anesthesiology Physical Status (ASA-PS) score.

Conclusion : The ASA-PS score is independently associated with outcomes in aSAH, though it is not utilized in current SAH prediction models. As a routinely assigned metric for any operation utilizing anesthesia, it is a practical candidate for inclusion in a more sophisticated SAH clinical prediction model. Additionally, aneurysm clipping was associated with vasospasm which may reflect recent improvements in endovascular techniques, and updated investigations into vasospasm prediction models which factor in treatment modality may be useful.