Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium s
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ORIGINAL ARTICLE - NEUROSURGERY GENERAL
Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium study Teemu Luostarinen 1 & Jarno Satopää 2 & Markus B Skrifvars 3 & Matti Reinikainen 4 & Stepani Bendel 4 & Sami Curtze 5 & Gerli Sibolt 5 & Nicolas Martinez-Majander 5 & Rahul Raj 2 Received: 28 April 2020 / Accepted: 18 June 2020 # The Author(s) 2020
Abstract Background 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. Methods We 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). Results Of 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. Conclusions Early 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. Keywords Intracerebral hemorrhage . Stroke . Surgery . Neurosurgery . Outcome . Mortality
This article is part of the Topical Collection on Neurosurgery general Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04470-y) contains supplementary material, which is available to authorized users. * Teemu Luostarinen [email protected] 1
Division of Anesthesiology, Department of Anesthesiology, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, PO BOX 266, 00029 HUS Helsinki, Finland
2
Department of Neurosurgery, Helsinki University Hospital and University of Hels
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