Key result
Aneurysmal SAH onset-to-treatment time is linked to U-shaped mortality risk lowest at ~33 hours.
Why the study?
What is the optimal onset-to-treatment time within 72 hours for surgical treatment in patients with aneurysmal subarachnoid hemorrhage to minimize mortality?
Cohort (n=3,560)
Yes
What is the optimal onset-to-treatment time within 72 hours for surgical treatment in patients with aneurysmal subarachnoid hemorrhage to minimize mortality?
Surgical treatment for aneurysmal subarachnoid hemorrhage may have an optimal window around 32.6 hours after symptom onset to minimize mortality.
Should not yet change aneurysmal SAH practice; leaves open need for prospective trials to confirm timing effects.
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 (χ 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.
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Wang et al. (2026) conducted a cohort in aneurysmal subarachnoid hemorrhage (aSAH) (n=3,560). Onset-to-treatment time was evaluated on all-cause mortality and 2-year dependent survival. Onset-to-treatment time demonstrated a nonlinear U-shaped association with all-cause mortality, with the lowest estimated mortality risk observed at approximately 32.6 hours after onset.
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