INTRACEREBRAL HEMORRHAGE: A TRANSITION PHASE TOWARD BETTER PROGNOSIS

BACKGROUND: In the United States, data on patient outcomes after operative\r\nmanagement of nontraumatic intracerebral hemorrhage (ICH) have been largely\r\nderived from tertiary care academic institutions. Given that outcomes of patients\r\ntreated at these specialized centers may differ from those treated at community\r\nhospitals, our aim was to report patient outcomes on a population-based,\r\nnational level.\r\n METHODS: The Nationwide Inpatient Sample (NIS) was utilized to identify all\r\npatients with a primary diagnosis of nontraumatic ICH (431.xx) who underwent a\r\ncraniotomy or craniectomy (ICD-9 CCS code 1). Univariate and multivariate\r\nanalyses were performed to analyze the effects of patient and hospital characteristics\r\non outcome measures.\r\n RESULTS: NIS estimated that 657,428 patients with a primary diagnosis of\r\nnontraumatic ICH were admitted between 1993 and 2003 in the United States,\r\n45,159 (6.9%) of whom underwent surgical treatment. The in-hospital mortality\r\nrate for surgically treated patients was 27.2%, and the complication rate was\r\n41.2%. The most common complications reported were pulmonary (30.4%), renal\r\n(3.2%), and thromboembolic (2.9%). A single postoperative complication increased\r\nthe mortality rate by 29% and lengthened the hospital stay by 5 days.\r\nMultivariate logistic regression demonstrated that complications and mortality\r\nwere more likely in patients of African-American descent, and in subjects with\r\n1 or more pre-existing comorbidity. Additionally, the mortality rate was lowest in\r\nhospitals that performed the highest volume of operations for nontraumatic ICH\r\n(odds ratio 0.8; 95% confidence interval 0.68 to 0.99).\r\n CONCLUSIONS: Patients with intracerebral hemorrhage who undergo craniotomy\r\nor craniectomy have a high morbidity and mortality. Male gender,\r\npreoperative comorbidities, complications, and low hospital volume were associated\r\nwith an increased risk of in-hospital mortality.