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Vol. 27. Num. 5.September - October 2016
Pages 207-262
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Vol. 27. Num. 5.September - October 2016
Pages 207-262
Clinical Research
DOI: 10.1016/j.neucir.2016.01.003
Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension
Estudio de supervivencia en hemorragia intracerebral espontánea con extensión intraventricular evacuada quirúrgicamente
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Ricardo Rivera-Fernándeza, Francisco Guerrero-Lópezb, David Rodríguez-Rubioc, Francisco Javier Gómez-Jiménezd, Francisco Rodríguez-Vilanovae, Juan Mora-Ordóñeze, Victoria Olea-Jiméneze, María Dolores Arias-Verdúe, Guillermo Quesada-Garcíae, Faustino Acebal-Blancof, Encarnación Castillo-Lorentef,
, Miguel Ángel Arráez-Sánchezg
a Intensive Care Medicine, Hospital de la Serranía, Ronda, Málaga, Spain
b Intensive Care Medicine, Hospital Virgen de las Nieves, Granada, Spain
c Neurosurgery Department, Hospital del Mar, Barcelona, Spain
d Universidad de Granada, Spain
e Intensive Care Medicine, Hospital Carlos Haya, Málaga, Spain
f Intensive Care Medicine, Hospital Neurotraumatológico, Jaén, Spain
g Neurosurgery Department, Hospital Carlos Haya, Málaga, Spain
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Tables (6)
Table 1. Relationship between mortality and rest of variables (age expressed in years, GCS and APACHE-II in points, length of ICU stay in days).
Table 2. Hospital mortality rates according to cathegorized GCS and age, confronted to patients with and without intraventricular hemorrhage (IVH).
Table 3. Relatioship between intraventricular hemorrhage (IVH) and rest of variables.
Table 4. Multivariant analysis of mortality in patients with intraventricular hemorrhage (n=163).
Table 5. Multivariant analysis of mortality in patients with supratentorial spontaneous intracerebral hemorrhage (n=263).
Table 6. Propensity score matching in two paired groups of 26 patients with intraventricular hemorrhage (surgical vs. medical treatment). No significant difference can be seen between both groups in considered variables except in mortality.
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Abstract
Objective

To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH).

Materials and methods

The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012. Data collected: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge

Results

A total of 263 patients were included. Mean age: 59.74±14.14 years. GCS: 8±4 points, APACHE II: 20.7±7.68 points. ICH Score: 2.32+1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p=0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n=78) versus those conservatively managed (58.9%, n=185); specifically in those with IVH surgically treated (34.2%, n=38) versus non-operated IVH (67.2%, n=125), p<0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33–3.22) in patients without IVH versus 0.19 (95% CI; 0.07–0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07–0.75), p=0.01.

Conclusions

Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhage.

Keywords:
Intracerebral hemorrhage
Surgery
Treatment
Resumen
Objetivo

Estudio de supervivencia y evaluación del tratamiento quirúrgico en una cohorte de pacientes con hematoma intracerebral espontáneo supratentorial.

Material y métodos

Incluidos todos los pacientes con hematoma cerebral espontáneo supratentorial ingresados en las unidades de cuidados intensivos de 3 hospitales españoles con servicios de neurocirugía (2009-2012). Se recogieron la edad, APACHE-II, escala de coma de Glasgow y alteraciones pupilares al ingreso, intracerebral haemorrhage (ICH) score, localización/volumen del hematoma, presencia de hemorragia intraventricular (IVH), evacuación quirúrgica±drenaje ventricular externo, supervivencia a los 30 días y hospitalaria.

Resultados

Doscientos sesenta y tres pacientes, con edad media 59,74±14,14 años, escala de coma de Glasgow: 8±4 puntos e ICH score: 2,32±1,04 puntos. El 30% presentaba alteraciones pupilares. Mortalidad a los 30 días: 51,3% (predicha por ICH score 45,3%) y hospitalaria 53,2%. Hubo diferencia estadísticamente significativa (p=0,004) entre la mortalidad-hospitalaria de los pacientes intervenidos quirúrgicamente (39,7%; n=78) frente a los tratados de modo conservador (58,9%; n=185), y específicamente para los pacientes intervenidos con IVH (34,2%; n=38) frente a los no operados con IVH (67,2%; n=125), (p<0,001). No hubo diferencias en la mortalidad de los pacientes sin IVH. En el análisis de regresión logística múltiple la OR para la cirugía fue 1,04 (IC 95%: 0,33-3,22) en pacientes sin IVH, frente a 0,19 (IC 95%: 0,07-0,53) en pacientes con IVH. El análisis con índice de propensión para pacientes con IVH demostró mejoría en la supervivencia del grupo operado (OR: 0,23; IC 95%: 0,07-0,75), p=0,01.

Conclusión

La mortalidad hospitalaria fue menor en los pacientes intervenidos quirúrgicamente en comparación con los tratados de modo conservador, específicamente para el subgrupo de pacientes con IVH.

Palabras clave:
Hemorragia intracerebral
Cirugía
Tratamiento

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