Long Term Outcomes Of Microsurgical Ruptured Aneurysm Clipping At A Rural Hospital In Kenya: A Retrospective Observational Study.

Abstract

Objective: To study the functional outcomes of ruptured aneurysm clipping and the impact of personnel and equipment improvements. Methods: From 2016-2022, 40 patients, or ⅔ of our entire aneurysm clipping volume, were divided into a “historical” group and “present” group to analyze the effects of personnel and equipment improvements. Data was extracted from the electronic medical record and functional status at discharge and last clinical follow-up calculated using the Modified Rankin Score (mRS). Results: In the historical group (2016-2017), 50% were male with a mean age of 54.7 (range 19-70). At discharge, after a mean of 11 days in the hospital, the median mRS was 2 (range 1-6) and there were 14 patients with an mRS of 0-3. 15 patients were available for follow-up at a mean of 11.35 days. The median mRS was 1 and 14 patients had an mRS of 0-3. In the present group (2020-2022), 10% were male with a mean age of 52.8 (range 29-76). At discharge, after a mean of 13.7 days in the hospital, the median mRS was 2.5 (range 1-6) and there were 12 patients with an mRS of 0-3. 17 patients were available for followup at a mean of 184.6 days. The median mRS was 0.5 and 17 patients had an mRS of 0-3. When comparing the number of patients with mRS 0-3 between each group, the p-value (0.295) was non-significant. Although the odds of death in the present group during hospitalization was lower, there was no significant difference (OR: 0.5, 95% CI: 0.108 to 2.6). Conclusion: Equipment and personnel improvements over time may contribute to improved patient outcomes. More neurosurgical centers need to be built, governments and other stakeholders should train more personnel and purchase the necessary equipment in Kenya and sub-saharan Africa.