Abstract TMP84: Contemporary Nationwide Estimates For Outcomes Associated With Craniotomy Among Patients With Intracerebral Hemorrhage

Abstract

Introduction: Contemporary nationwide estimates of outcomes associated with craniotomy procedures (CP) among patients with primary intracerebral hemorrhage (ICH) are lacking. Methods: From the nationwide inpatient sample (2016 - 2019), we identified adults discharged with primary ICH diagnosis and those who received CP. We fit a series of multivariable logistic regression models to report the adjusted odds ratios (aOR) and 95% confidence interval (CI) for factors associated with receiving CP and the association of CP with in-hospital mortality, home discharge, and development of major complication (MCC): brain abscess, sepsis, deep vein thrombosis, urinary tract infection, and pneumonia. We also fit generalized linear model (γ family) to report the adjusted mean ratio (aMR) and CI for the association of craniotomy with length of stay (LOS) and cost of care. Results: Among 271 840 ICH hospitalizations (mean age [SD] 68.2 [14.9] years; 48% females), 15.3% received CP. Utilization of CP increased from 14.6% in 2016 to 15.8% in 2019 (aOR, CI: 1.10, 1.00 -1.21). Factors independently associated with lower odds of receiving CP (aOR, CI) are older age (0.97, 0.97 - 0.97); Hispanic ethnicity (0.87, 0.78 - 0.97) and Asian race (0.84, 0.73 - 0.96) (vs. Non-Hispanic White); congestive heart failure (0.86, 0.79 - 0.95); diabetes (0.79, 0.72 - 0.87) and renal failure (0.68, 0.62 - 0.74). Private (vs. Medicare) insurance (1.23, 1.13 - 1.34); and residence in large metropolitan (vs. non-metropolitan) counties (1.14, 1.03 - 1.25) is associated with higher odds of receiving a CP. CP is associated with significantly lower odds of in-hospital mortality (aOR, CI: 0.66, 0.61 - 0.72) and home discharge (0.51, 0.45 - 0.57). However, CP ICH patients had longer LOS (aMR, CI: 1.79. 1.75 - 1.84) and higher cost of care (1.82, 1.79 - 1.85). CP is not associated with MCC (aOR, CI: 0.99, 0.92 - 1.07). Conclusions: Modern-day craniotomy procedures likely improve ICH in-patient survival and are not associated with major complications. Large, pragmatic clinical trials for ICH patients are needed to evaluate effectiveness of craniotomy, particularly minimally invasive procedures, on longer term mortality and functional outcomes.