Clinical and Radiological Determinants of Early Functional Outcome After Microsurgical Clipping for Aneurysmal Subarachnoid Hemorrhage

INTRODUCTION: To identify clinical and radiological factors associated with early functional outcome at hospital discharge among patients with aneurysmal subarachnoid hemorrhage (aSAH) treated exclusively with microsurgical clipping.
METHODS: This retrospective single-center cohort study included 186 adult patients with aSAH who underwent microsurgical aneurysm clipping between April 2022 and April 2025. Demographic variables, vascular risk factors, admission neurological status assessed by the Glasgow Coma Scale (GCS) and Hunt–Hess grade, and radiological hemorrhage severity assessed by the Modified Fisher score were recorded. Functional outcome at hospital discharge was evaluated using the modified Rankin Scale (mRS) and dichotomized into good (mRS <3) and poor (mRS ≥3) outcome groups.
RESULTS: Poor functional outcome at hospital discharge (mRS ≥3) was observed in 82 patients (44.1%). Patients with poor outcome were older (58.6 ± 11.2 vs. 47.9 ± 10.6 years, p < 0.001). In multivariable analysis, older age (adjusted OR 1.04, 95% CI 1.01–1.07), lower admission GCS (adjusted OR 0.82, 95% CI 0.75–0.89), higher Hunt–Hess grade (adjusted OR 1.91, 95% CI 1.34–2.71), and higher Modified Fisher score (adjusted OR 1.76, 95% CI 1.22–2.54) were independently associated with poor outcome (all p ≤ 0.002). Admission GCS showed the highest individual discriminative performance (AUC 0.82), while the combined clinical–radiological model showed the best overall discrimination (AUC 0.88). In-hospital mortality was 11.3%.
DISCUSSION AND CONCLUSION: In patients with aSAH treated exclusively with microsurgical clipping, early functional outcome at hospital discharge was primarily associated with age, admission neurological severity, and radiological hemorrhage burden. Integrated clinical–radiological assessment may support early risk stratification, although external validation is needed.