Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension

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• 作者：Ricardo Rivera-Ferná ; ndez^a ; Francisco Guerrero-Ló ; pez^b ; David Rodrí ; guez-Rubio^c ; Francisco Javier Gó ; mez-Jimé ; nez^d ; Francisco Rodrí ; guez-Vilanova^e ; Juan Mora-Ordó ; &ntilde ; ez^e ; Victoria Olea-Jimé ; nez^e ; Marí ; a Dolores Arias-Verdú ; ^e ; Guillermo Quesada-Garcí ; a^e ; Faustino Acebal-Blanco^f ; Encarnació ; n Castillo-Lorente^f ; ^{encarnacioncastillo@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{encarnacion.castillo.sspa@juntadeandalucia.es" class="auth_mail" title="E-mail the corresponding author} ; Miguel Á ; ngel Arrá ; ez-Sá ; nchez^g
• 关键词：Intracerebral hemorrhage ; Surgery ; Treatment
• 刊名：Neurocirugía
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：27
• 期：5
• 页码：220-228
• 全文大小：656 K

文摘

To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH).

Materials and methods

The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012. Data collected: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge

Results

A total of 263 patients were included. Mean age: 59.74 ± 14.14 years. GCS: 8 ± 4 points, APACHE II: 20.7 ± 7.68 points. ICH Score: 2.32 + 1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p = 0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n = 78) versus those conservatively managed (58.9%, n = 185); specifically in those with IVH surgically treated (34.2%, n = 38) versus non-operated IVH (67.2%, n = 125), p < 0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33–3.22) in patients without IVH versus 0.19 (95% CI; 0.07–0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07–0.75), p = 0.01.

Conclusions

Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhage.