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Background <p>The optimal timing of surgery for aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. This study aims to identify the optimal surgical window within 72&#xa0;h of symptom onset.</p> Methods <p>Patients with aSAH who underwent surgical treatment within 72&#xa0;h of onset were identified from the Chinese Multicenter Cerebral Aneurysm Database (2017–2020). Multivariable Cox and logistic regression models with restricted cubic splines (RCS) were used to assess associations between onset-to-treatment time and all-cause mortality and 2-year dependent survival, respectively.</p> Results <p>A total of 3560 patients with aSAH were included. During a mean follow-up of 30.9 ± 22.5&#xa0;months, 521 deaths were recorded, yielding a 2-year mortality rate of 12.9%. The RCS analysis revealed a significant U-shaped relationship between onset-to-treatment time and all-cause mortality (<i>χ</i><sup>2</sup> = 5.88, <i>df</i> = 1, <i>P</i> = 0.015), as well as a significant overall association (<i>χ</i><sup>2</sup> = 6.73, <i>df</i> = 2, <i>P</i> = 0.035). The lowest risk of all-cause mortality was observed at 32.6&#xa0;h after onset. A monotonically decreasing association was observed between onset-to-treatment time and 2-year dependent survival (<i>χ</i><sup>2</sup> = 3.70, <i>df</i> = 1, <i>P</i> = 0.055). Specifically, the risk of 2-year dependent survival declined rapidly with treatment delay during the first 12&#xa0;h after onset and plateaued at approximately 32.6&#xa0;h.</p> Conclusion <p>The time from onset to treatment demonstrated a nonlinear (U-shaped) association with all-cause mortality and a linear association with 2-year dependent survival, with the lowest estimated mortality risk observed at approximately 32.6&#xa0;h after onset.</p>

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Association of onset-to-treatment time and outcomes after aneurysmal subarachnoid hemorrhage: a multicenter cohort study

  • 期刊论文

  • 发表日期：

    2026年2月7日

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  • Bangyue Wang,
  • Xiuhu An,
  • Changkai Hou,
  • Ruyi Wang,
  • Jian Li,
  • Yan Zhao,
  • Yang Li,
  • Yanfen Chai,
  • Xinyu Yang,
  • Zhenbo Liu,
  • Minfeng Tong

摘要

Background

The optimal timing of surgery for aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. This study aims to identify the optimal surgical window within 72 h of symptom onset.

Methods

Patients with aSAH who underwent surgical treatment within 72 h of onset were identified from the Chinese Multicenter Cerebral Aneurysm Database (2017–2020). Multivariable Cox and logistic regression models with restricted cubic splines (RCS) were used to assess associations between onset-to-treatment time and all-cause mortality and 2-year dependent survival, respectively.

Results

A total of 3560 patients with aSAH were included. During a mean follow-up of 30.9 ± 22.5 months, 521 deaths were recorded, yielding a 2-year mortality rate of 12.9%. The RCS analysis revealed a significant U-shaped relationship between onset-to-treatment time and all-cause mortality (χ2 = 5.88, df = 1, P = 0.015), as well as a significant overall association (χ2 = 6.73, df = 2, P = 0.035). The lowest risk of all-cause mortality was observed at 32.6 h after onset. A monotonically decreasing association was observed between onset-to-treatment time and 2-year dependent survival (χ2 = 3.70, df = 1, P = 0.055). Specifically, the risk of 2-year dependent survival declined rapidly with treatment delay during the first 12 h after onset and plateaued at approximately 32.6 h.

Conclusion

The time from onset to treatment demonstrated a nonlinear (U-shaped) association with all-cause mortality and a linear association with 2-year dependent survival, with the lowest estimated mortality risk observed at approximately 32.6 h after onset.