Purpose: Aneurysmal subarachnoid hemorrhage is an urgent manner in which blood accumulates in the subarachnoid region. Presence of chronic kidney disease (CKD) is often a predictor of adverse outcomes perioperatively. Patients with CKD may have different perioperative outcomes during surgery for aneurysmal subarachnoid hemorrhage compared to patients without CKD, and we sought to retrospectively examine the effect of CKD on perioperative outcomes in aSAH patients receiving surgery.

Methods: Patients undergoing craniotomy for aneurysmal subarachnoid hemorrhage were analyzed using the ACS-NSQIP database from 2005-2021. Patients with CKD were defined based on estimated glomerular filtration rate (eGFR) < 60 mL/min. 30-day postoperative outcomes were compared between the two groups and included death, cardiac complications renal complications, sepsis, pulmonary complications, return to the operating room (OR), and operation time greater than four hours, among other variables.

Results: There were 122 CKD patients and 1,456 non-CKD aSAH patients who underwent craniotomy identified. Compared to non-CKD patients, CKD patients had increased risk of mortality (30.33% vs 12.84%, aOR 1.862, p=0.0097), renal complications (4.92% vs 0.82%, aOR 3.911, p=0.0208), and bleeding perioperatively (31.97% vs 14.56%, aOR 2.369, p<0.0001).

Conclusion: This study demonstrated that CKD patients with aneurysmal subarachnoid hemorrhage receiving craniotomy have increased risk of death, renal complications, and bleeding perioperatively.