• Vasconcellos de Oliveira SouzaNatáliaNDepartment of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstei, Carolina Rouanet, Fontoura SollaDavi JorgeDJDepartment of Neurology and Neurosurgery, Universidade de São Paulo, Sao Paulo, Brazil., Barroso de LimaCaio ViníciusCVDepartment of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil., Juliana Trevizo, Flavio Rezende, Maramelia Miranda Alves, Airton Leonardo de Oliveira Manuel, Cassia Righy, Feres Chaddad Neto, Michel Frudit, and Gisele Sampaio Silva.
• Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil. Electronic address: dranataliavasconcellos@gmail.com.
• World Neurosurg. 2024 Mar 1; 183: e250e260e250-e260.

ObjectiveAlmost two thirds of the world's aneurysmal subarachnoid hemorrhage (aSAH) are in low- and middle-income countries. Herein, we aimed to evaluate the impact of complications on the outcome of aSAH in a middle-income country.MethodsBaseline data (age, sex, World Federation of Neurosurgical Society, time ictus-treatment, treatment modality) and medical and neurologic complications from a cohort in Brazil (2016-2019) were evaluated: delayed cerebral ischemia; hydrocephalus; meningitis; seizures; intracranial hypertension; infections (pneumonia, bloodstream, urinary tract infection infection of undetermined source); sodium disturbances; acute kidney injury; and cardiac and pulmonary complications. The primary outcome was the modified Rankin scale (mRS) at hospital discharge. Univariate and multivariate models were employed.ResultsFrom 212 patients (71.7% female, age 52.7 ± 12.8), 92% developed at least 1 complication (any infection-43.9%, hydrocephalus-34.4%, intracranial hypertension-33%, infection of undetermined source-20.8%, hypernatremia-20.8%, hyponatremia-19.8%, delayed cerebral ischemia-related infarction-18.7%, pneumonia-18.4%, acute kidney injury-16.5%, and seizures-11.8%). In unadjusted analysis, all but hyponatremia and urinary tract infection were associated with mRS 3-6 at discharge; however, complications explained only 12% of the variation in functional outcome (mRS). Most patients were treated by clipping (66.5%), and 15.6% (33 patients) did not receive a definitive treatment. The median time ictus-admission and ictus-treatment were 5 and 9 days, respectively.ConclusionsWhile medical and neurologic complications are a recognized opportunity to improve aSAH care, low- and middle-income countries comprise 70% of the world population and still encounter difficulties concerning early definitive aneurysm treatment, rebleeding, and human and material resources.Copyright © 2023 Elsevier Inc. All rights reserved.

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