Surgical results for hypertensive intracerebral hemorrhagesdepending on intervention timing

Abstract

Study aim. To analyse the surgical outcomes in patients with haemorrhagic stroke depending on the timing of surgery.
 Materials and methods. We performed a retrospective analysis of 500 patients (335 (67%) men and 165 (33%) women), who underwent surgical treatment of hypertensive intracranial hemorrhages at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 1997 and 2020. The mean patient age was 53.1 12.2 years. The mean time until surgery was 3.3 2.6 days. Outcomes were assessed on day 30 from disease onset using the modified Rankin Scale (mRS).
 Results. In the total sample, outcomes as measured by the mRS were as follows: type 0 84 (16.8%) patients, type 1 37 (7.4%), type 2 46 (9.2%), type 3 38 (7.6%), type 4 43 (8.6%), type 5 142 (28.4%) and type 6 110 (22.0%). Treatment results were better when surgery was delayed (2 = 64.4; p 0.00001). Mortality was 36.4% after surgery conducted in the first day after haemorrhage, while mRS scores of 02 made up 18.6%. Mortality was 20.4% after surgery conducted on the second or third day, and mRS scores of 02 made up 29.6%. Mortality was 17.4% after surgery conducted on day 47, and mRS scores of 02 outcomes were present in 49.0% of subjects. Mortality was 8.8% when surgery was performed on day 8 or later, and favourable outcomes were present in 48.5% of patients.
 Conclusion. Intracerebral haematoma excision on day 23 leads to better outcomes in patients with reduced levels of alertness up to sopor, while surgery after day 3 leads to better results in alert patients and those with obtundation.