Early rehabilitation initiation after aneurysmal subarachnoid haemorrhage: evaluation of mortality and functional outcomes.
Evidence regarding the optimal timing of rehabilitation after aneurysmal subarachnoid haemorrhage (aSAH) remains limited. In this study, we aimed to evaluate clinical outcomes associated with initiating rehabilitation within 48 h after aneurysm securing.
We conducted a retrospective cohort study emulating a target trial using the Diagnosis Procedure Combination claims database (651 acute-care hospitals), which contains administrative data with limited clinical granularity. We included adults (≥18 years) with aSAH who underwent endovascular coiling or surgical clipping on hospital day 1 and had prestroke mRS scores of 0-2. Early rehabilitation was defined as initiation within 48 h after aneurysm securing; the comparator was initiation after 48 h. Using a clone-censoring-weighting approach, we estimated per-protocol hazard ratios for 30-day mortality and poor functional outcome (mRS scores of 3-6). Sensitivity analyses were conducted using alternative initiation thresholds (72, 96 and 120 h).
Among 7544 patients (mean age, 62.6 years; 69.7% women), crude 30-day mortality was 2.6% in the early initiation group and 1.5% in the deferred initiation group. In the per-protocol analysis, early rehabilitation was associated with higher 30-day mortality (hazard ratio [HR], 1.82; 95% CI, 1.21-2.63) and a higher risk of poor functional outcome (HR, 1.31; 95% CI, 1.08-1.55). This association was attenuated when "early" was defined after 72 h (mortality HR, 1.34; 95% CI, 0.87-2.07).
Initiating rehabilitation within 48 h after aneurysm securing was associated with worse short-term outcomes, whereas deferring initiation until after 72 h attenuated the excess risk.
These findings suggest that the first 48 h may represent a higher-risk window for routine rehabilitation initiation in acute aSAH care.
We conducted a retrospective cohort study emulating a target trial using the Diagnosis Procedure Combination claims database (651 acute-care hospitals), which contains administrative data with limited clinical granularity. We included adults (≥18 years) with aSAH who underwent endovascular coiling or surgical clipping on hospital day 1 and had prestroke mRS scores of 0-2. Early rehabilitation was defined as initiation within 48 h after aneurysm securing; the comparator was initiation after 48 h. Using a clone-censoring-weighting approach, we estimated per-protocol hazard ratios for 30-day mortality and poor functional outcome (mRS scores of 3-6). Sensitivity analyses were conducted using alternative initiation thresholds (72, 96 and 120 h).
Among 7544 patients (mean age, 62.6 years; 69.7% women), crude 30-day mortality was 2.6% in the early initiation group and 1.5% in the deferred initiation group. In the per-protocol analysis, early rehabilitation was associated with higher 30-day mortality (hazard ratio [HR], 1.82; 95% CI, 1.21-2.63) and a higher risk of poor functional outcome (HR, 1.31; 95% CI, 1.08-1.55). This association was attenuated when "early" was defined after 72 h (mortality HR, 1.34; 95% CI, 0.87-2.07).
Initiating rehabilitation within 48 h after aneurysm securing was associated with worse short-term outcomes, whereas deferring initiation until after 72 h attenuated the excess risk.
These findings suggest that the first 48 h may represent a higher-risk window for routine rehabilitation initiation in acute aSAH care.
Authors
Tani Tani, Nozoe Nozoe, Ikeda Ikeda, Kubo Kubo, Takara Takara, Tokuda Tokuda, Matsuki Matsuki, Fushimi Fushimi
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