Impact of surgery within 6 hours on preoperative rerupture and prognosis of poor-grade aneurysmal subarachnoid hemorrhage

Xiaomei Xu, Qiuyan Shen, Dan Wang, Shibai Sun, Wenwen Che, Yuhai Wang

Objective Preoperative rerupture is a major cause of poor outcome in poor-grade aneurysmal subarachnoid hemorrhage (PaSAH). The optimal surgical timing is controversial. This study aims to investigate the effect of surgery within 6 h on preoperative rerupture and the prognosis of PaSAH. Methods A retrospective study was performed on 140 PaSAH patients treated at the Neurosurgery Department of the 904th Hospital of the Joint Logistics Support Force between July 2017 and July 2025, with a 6-month postoperative follow-up. Patients were divided into two groups: the surgery within 6 h group and the surgery beyond 6 h group, based on the time from aneurysm rupture to surgery. Results Of the 140 patients, 83 (59.3%) were in the surgery within 6 h group, and 57 (40.7%) were in the surgery beyond 6 h group. The surgery within 6 h group had significantly higher proportions of H-H classification, mFisher classification, and decompressive flap use, while the proportion of acute hydrocephalus was notably lower, with statistically significant differences ( p < 0.05). Compared to the surgery beyond 6 h group, the surgery within 6 h group demonstrated a 17.9% reduction in the preoperative aneurysm rerupture rate (8.4% vs. 26.3%), a 7.5% lower 30-day all-cause mortality rate (24.1% vs. 31.6%), and a 7% higher rate of favorable 6-month outcomes (38.6% vs. 31.6%). After adjusting for acute hydrocephalus, H-H classification, and mFisher classification, the analysis revealed that surgery beyond 6 h significantly increased the risk of preoperative rerupture compared to surgery within 6 h ( RR = 3.188, 95% CI 1.335–7.616, p = 0.009). Furthermore, after adjusting for preoperative rerupture, surgery within 6 h significantly improved prognosis ( RR = 1.145, 95% CI 1.030–1.274, p = 0.012). Conclusion Surgery within 6 h effectively reduces the risk of preoperative rerupture in PaSAH patients and significantly improves long-term outcomes.