İlhan AYDIN, Berkay KEF
Comprehensive Medicine - 2026;18(3):318-325
Objective: Early aneurysm occlusion is a cornerstone in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent rebleeding and secondary brain injury. However, whether operative timing, particularly during off-hours, influences clinical outcomes remains uncertain. To evaluate the association between operative timing and clinical outcomes in patients undergoing treatment for ruptured intracranial aneurysms. Materials and Methods: This retrospective cohort study included adult patients treated for ruptured intracranial aneurysms at a tertiary neurosurgical center between January 2021 and January 2026. Procedures were categorized as work hours (07:00-16:00), evening (16:00-22:00), and nighttime (22:00-07:00). The primary outcome was functional status at discharge, assessed using the modified Rankin Scale (mRS). Secondary outcomes included mortality and length of hospital stay. Multivariable logistic regression was used to determine whether operative timing independently predicted poor outcome (mRS >=3) after adjustment for clinical and radiological severity variables. Results: A total of 315 patients were included, of whom 79.4% were treated during work hours, 10.5% in the evening, and 10.1% at night. Baseline demographic, clinical, and radiological characteristics were comparable across groups. Favorable outcome (mRS 0-2) occurred in 64.0%, 57.6%, and 50.0% of patients, respectively (p=0.21), while mortality rates were 12.8%, 15.1%, and 21.9% (p=0.18). In multivariable analysis, WFNS >=IV, ASA >=3, and Fisher >=III were independently associated with poor outcome, whereas operative timing was not. Conclusion: Although later operative timing showed a trend toward worse crude outcomes, it was not independently associated with clinical outcomes after adjustment for disease severity. Patient-related factors appear to be the primary determinants of outcome in aSAH.
