Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium study

Teemu Luostarinen,Markus B Skrifvars,Jarno Satopää,Stepani Bendel,Sami Curtze,Rahul Raj,Matti Reinikainen,Gerli Sibolt,Nicolas Martinez-Majander

doi:10.1007/s00701-020-04470-y

Abstract

BackgroundThe benefits of early surgery in cases of superficial supratentorial spontaneous intracerebral hemorrhage (ICH) are unclear. This study aimed to assess the association between early ICH surgery and outcome, as well as the cost-effectiveness of early ICH surgery.MethodsWe conducted a retrospective, register-based multicenter study that included all patients who had been treated for supratentorial spontaneous ICH in four tertiary intensive care units in Finland between 2003 and 2013. To be included, patients needed to have experienced supratentorial ICHs that were 10–100 cm3 and located within 10 mm of the cortex. We used a multivariable analysis, adjusting for the severity of the illness and the probability of surgical treatment, to assess the independent association between early ICH surgery (≤ 1 day), 12-month mortality rates, and the probability of survival without permanent disability. In addition, we assessed the cost-effectiveness of ICH surgery by examining the effective cost per 1-year survivor (ECPS) and per independent survivor (ECPIS).ResultsOf 254 patients, 27% were in the early surgery group. Overall 12-month mortality was 39%, while 29% survived without a permanent disability. According to our multivariable analysis, early ICH surgery was associated with lower 12-month mortality rates (odds ratio [OR] 0.22, 95% confidence intervals [CI] 0.10–0.51), but not with a higher probability of survival without permanent disability (OR 1.23, 95% CI 0.59–2.56). For the early surgical group, the ECPS and ECPIS were €111,409 and €334,227, respectively. For the non-surgical cohort, the ECPS and ECPIS were €76,074 and €141,471, respectively.ConclusionsEarly surgery for superficial ICH is associated with a lower 12-month mortality risk but not with a higher probability of survival without a permanent disability. Further, costs were higher and cost-effectiveness was, thus, worse for the early surgical cohort.

Highlights

Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and morbidity rates [15]
Using data on ICH patients that were available in a large, retrospective multicenter intensive care unit (ICU) database, we assessed the association between early ICH surgery and mortality rates after spontaneous supratentorial ICH, using the same inclusion criteria that were used for STICH II [14]
We hypothesized that when compared to non-surgical treatment, early surgery would be associated with lower mortality rates but not with an increased rate of survival without permanent disability

Summary

Introduction

Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and morbidity rates [15]. It is a great burden on healthcare systems, and the associated treatment costs are high because it requires an extended rehabilitation period [17, 20]. Despite there being multiple randomized studies into the issue, it is still unclear what the benefits are to surgery being carried out during the early stages of ICH treatment [13, 14, 23]. Our hypothesis was that early ICH surgery would be associated with lower cost-effectiveness per 1-year survivor but with increased costeffectiveness per independent survivor. The benefits of early surgery in cases of superficial supratentorial spontaneous intracerebral hemorrhage (ICH) are unclear. This study aimed to assess the association between early ICH surgery and outcome, as well as the cost-effectiveness of early ICH surgery

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