Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage.
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Kuramatsu Joji B, Biffi Alessandro, Gerner Stefan T, Sembill Jochen A, Sprügel Maximilian I, Leasure Audrey, Sansing Lauren, Matouk Charles, Falcone Guido J, Endres Matthias, Haeusler Karl Georg, Sobesky Jan, Schurig Johannes, Zweynert Sarah, Bauer Miriam, Vajkoczy Peter, Ringleb Peter A, Purrucker Jan, Rizos Timolaos, Volkmann Jens, Müllges Wolfgang, Kraft Peter, Schubert Anna-Lena, Erbguth Frank, Nueckel Martin, Schellinger Peter D, Glahn Jörg, Knappe Ulrich J, Fink Gereon R, Dohmen Christian, Stetefeld Henning, Fisse Anna Lena, Minnerup Jens, Hagemann Georg, Rakers Florian, Reichmann Heinz, Schneider Hauke, Rahmig Jan, Ludolph Albert Christian, Stösser Sebastian, Neugebauer Hermann, Röther Joachim, Michels Peter, Schwarz Michael, Reimann Gernot, Bäzner Hansjörg, Schwert Henning, Claßen Joseph, Michalski Dominik, Grau Armin, Palm Frederick, Urbanek Christian, Wöhrle Johannes C, Alshammari Fahid, Horn Markus, Bahner Dirk, Witte Otto W, Günther Albrecht, Hamann Gerhard F, Hagen Manuel, Roeder Sebastian S, Lücking Hannes, Dörfler Arnd, Testai Fernando D, Woo Daniel, Schwab Stefan, Sheth Kevin N, Huttner Hagen B
Аннотация
OBJECTIVE: To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH.
DESIGN, SETTING, AND PARTICIPANTS: Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015).
EXPOSURE: Surgical hematoma evacuation vs conservative treatment.
MAIN OUTCOMES AND MEASURES: The primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS, 4-6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH.
RESULTS: Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm3 vs 18.8 cm3). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], -3.7% [95% CI, -8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm3 was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume ≤12 cm3, 30.6% vs 62.3% [P = .003]; ARD, -34.7% [-38.8% to -30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume ≥15 cm3, 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02).
CONCLUSIONS AND RELEVANCE: Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.