Abstract TP440: Predictors and Associated Outcomes With Unanticipated Surgical Evacuation in Patients With Intracerebral Hemorrhage: Post Hoc Analysis of ATACH 2 Trial

Abstract

Background: We performed this analysis to identify the rates, predictors and associated outcomes of unexpected neurosurgical intervention in a multicenter clinical trial, Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2, involving good grade patients with intracerebral hemorrhage (ICH). Methods: The ATACH 2 Trial determined the relative efficacy of intensive versus standard antihypertensive treatment in subjects with spontaneous supratentorial ICHs with a Glasgow Coma Scale (GCS) score of ≥5 and intraparenchymal hematoma volume of < 60 cm3 on initial computed tomographic (CT) scan in whom surgical evacuation was not anticipated. We performed logistic regression analyses to determine the effect of unanticipated surgical intervention on death or disability at 3 months, death within 3 months, after adjusting for age and initial hematoma volume presence of intraventricular hemorrhage, and initial GCS score strata (14-15,9-13,8 or less). Results: Among the 992 subjects analyzed, 44 (4.4%) subjects required unanticipated surgical evacuation of hematoma. The mean time interval between randomization and surgical intervention was 1.6 days (±SD 3.7 days). In multivariate analyses, subjects who underwent unanticipated surgical evacuation had a significant higher risk of death or disability (OR 3.6, 95% confidence interval [CI] 1.6 - 8.3; p-value .002) at 3 months and mortality (OR 2.9, 95% CI 1.1 - 7.6; p-value .03) within 3 months after adjusting for potential confounders. Conclusions: In the large cohort of ATACH-2 subjects with good grade ICH, the rates of unanticipated surgical evacuation were low and associated with high rates of death or disability at 3 months.