Impact of stereotactic hematoma evacuation on medical costs during the chronic period in patients with spontaneous putaminal hemorrhage: a randomized study.
OBJECTIVE
Stereotactic hematoma evacuation (SHE) has been reported to reduce mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic hematoma evacuation has not been widely accepted, however, as a standard therapy because its effect on functional outcome has been regarded as marginal and insufficient to justify the costs of surgery. We reassessed the value of SHE by analyzing its impact on chronic-period medical costs based on an original randomized study carried out by us.


METHODS
In total, 490 patients were entered into the study. The degree of neurologic severity was defined on admission according to the neurologic grades (NGs) ranging from NG1 to NG5, adopted by the Japanese Cooperative Study on Stroke Surgery. The NG2 and 3 patients were randomized into 2 groups with different treatment protocols (group I, SHE; group II, conservative treatment). On the other hand, the NG1, 4, and 5 patients were excluded from the randomization because a large-scale retrospective study in Japan had revealed that surgical treatment in patients assigned to these NG grades does not improve functional outcome. Among the 490 patients, 248 were excluded and 242 were randomized strictly. The latter patients comprised 148 men and 94 women. Their ages ranged from 38 to 80 years (mean, 60.5 years). The medical costs for patient care were analyzed at 1 year after onset.


RESULTS
As compared with group II, group I demonstrated a lower mortality and better recovery to functional independence in NG3 patients. As compared with group II, group I revealed lower costs at 1 year after hemorrhage in NG2 patients, probably reflecting reduced neurologic deficits brought about by the SHE, and approximately the same costs in NG3 patients.


CONCLUSIONS
Stereotactic hematoma evacuation is clearly of value from the medicoeconomical point of view in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but open to weak stimuli (NG2) or strong stimuli (NG3) on admission.
Hattori
Naoyuki
N
Department of Neurological Surgery, Nihon University School of Commerce, Tokyo 173-8610, Japan. nh1026@bf6.so-net.ne.jp
Katayama
Yoichi
Y
Maya
Yoshio
Y
Gatherer
Alexander
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D046648:Hematoma, Subdural, Intracranial / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020146:Putaminal Hemorrhage / Q000150:complications / Q000191:economics* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques / Q000191:economics*; D016896:Treatment Outcome; D006113:United Kingdom