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  • The Effect of Body-Mass Index on Delayed Ischemia and Outcomes after Aneurysmal Subarachnoid Hemorrhage

    Final Number:

    Joshua David Hughes MD; Anthony Michael Burrows MD; Alejandro A. Rabinstein

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Obesity is increasing world-wide. Evidence shows stroke patients with higher body-mass index (BMI) have better survival outcomes than those with lower BMI. The evidence is conflicting regarding BMI and complications and outcomes in aneurysmal subarachnoid hemorrhage (aSAH).

    Methods: Records of a prospective series of 283 aSAH patients from 2002-2011 were reviewed for demographics; BMI (kg/m2); medical comorbidities; GCS,WFNS, and mFS at presentation; delayed cerebral ischemia (DCI), symptomatic vasospasm (SV), and radiographic infarct (RI); and Glascow Outcome Scores (GOS) at 3 months or greater. The population was separated into the following BMI categories: group 1, <25 kg/m2; group 2, 25-<30 kg/m2; and group 3, >30 kg/m2. Statistical analysis comparing comorbidities and characteristics of aSAH between groups included t-tests and Chi-squared tests. Odds ratios were used to compare the risk of DVI, SV, and RI and GOS. Univariate and multivariate logistic regression with odds ratios (OR) and confidence intervals (CI) analyzed BMI as a continuous variable.

    Results: Group 1 had 93 patients with an average BMI of 22.4±1.8, group 2 had 101 patients with an average BMI of 27.6±1.4, and group 3 had 89 patients with an average BMI of 35.7±4.6 (p<0.05 between groups). Regarding comorbidities and aSAH presentation and treatment, the only difference was a greater prevalence of hypertension, diabetes mellitus, and clipping in group 3 compared with group 1 (Table 1). There was no significant association between BMI group and DCI, SV, RI, or GOS (Table 2). Neither univariate nor multivariate logistic regression analyses (including age, WFNS, modified Fisher score, and BMI) showed any significant relationship between BMI and DCI, SV, RI, or GOS. BMI was not associated with any of the outcome measures in analysis adjusted for modality of aneurysm treatment.

    Conclusions: In our cohort, BMI did not influence the likelihood of delayed ischemia or alter functional outcomes after aSAH.

    Patient Care: By showing that obese patients do not have worse outcomes after subarachnoid hemorrhage

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Better understand the effect of BMI with complications and outcomes in subarachnoid hemorrhage

    References: Doehner W, Schenkel J, Anker, SD, et al. Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eurpoean Heart Journal 2013; 34: 268-77. Juevela S, Siironen J, Kuhmonen J. Hyerpglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneyurysmal subarachnoid hemorrhage. J Neurosurg 2005; 102: 998-1003. Schultheiss KE, Jang YG, Yanowitch RN, et al. Fat and Neurosurgery: Does Obesity Affect Outcome After Intracranial Surgery? Neurosurg 2009; 64:316-27.

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