Assessment of Adverse Events Using the Therapy–Disability–Neurology (TDN) Grading System in a Cohort of Aneurysmal Subarachnoid Hemorrhage Patients: A Single-Center Retrospective Cohort Study

Background/Objectives: Adverse events (AE) associated with neurosurgical interventions can cause neurological deficits and impaired functional outcomes. The Therapy–Disability–Neurology (TDN) grade classifies AE severity based on treatment requirements, disability, and neurological deficits, but has not been validated in aneurysmal subarachnoid hemorrhage (aSAH). We aimed to validate the TDN grade in predicting functional outcomes and length of hospital stay (LOS) in aSAH patients, treated surgically and/or endovascularly. Methods: We conducted a single-center retrospective cohort study of a prospectively collected database of aSAH patients. Patients were recruited between 2009 and 2022. The TDN grade was retrospectively applied. Primary outcome variables were functional outcomes, assessed using the Glasgow Outcome Scale (GOS, selected for comparability with prior aSAH outcome literature), at discharge and last follow-up, and LOS. Results: We included 355 patients: mean age was 57.2 (12.9 SD) and 235 (66.1%) were female. The TDN grade showed a moderate positive correlation with length of hospital stay (rho = 0.4, p < 0.001). Negative correlations were observed with functional outcomes at discharge (GOS: rho = −0.56, p < 0.0001) and at last follow-up (GOS: rho = −0.58, p < 0.0001). The TDN grade demonstrated good discrimination for unfavorable outcome at last follow-up (AUC = 0.82) and good discrimination for employment status (AUC = 0.71). Patients with AEs stayed 7.63 days longer on average (p < 0.001). Conclusions: The TDN grade predicted hospital stay and functional outcomes in aSAH patients treated surgically and/or endovascularly, demonstrating good discrimination for unfavorable outcomes and employment status. These findings extend the grade’s applicability to both treatment- and disease-related complications and support its potential utility as a standardized tool for prognostication and resource planning. Results should be interpreted in light of the single-center retrospective design and selection bias.