title: A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage.
abstract: OBJECTIVE
  The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study.
  
  
  METHODS
  We identified all subjects with primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland. Hematoma evacuation was carried out by using standard craniotomy or through a burr hole. We compared mortality rates and functional outcomes of patients with hematoma evacuation with those treated conservatively.
  
  
  RESULTS
  Of 982 patients with verified ICH during the study period, 127 (13%) underwent hematoma evacuation. Surgically treated patients were significantly younger (mean±SD, 63±11 vs. 70±12 years; p<0.001), had larger hematomas (66±36 vs. 28±40 ml; p<0.001), lower Glasgow Coma Scale scores (median, 11 vs. 14; p<0.001) and more frequently subcortical hematomas (68% vs. 24%; p<0.001) than those treated conservatively. In multivariable analysis, hematoma evacuation independently lowered 3-month mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.88; p<0.03), particularly among patients aged≤70 years with ≥30 ml supratentorial hematomas (adjusted HR, 0.26; 95% CI, 0.14-0.49; p<0.001). However, poor outcome was not improved by surgery (adjusted odds ratio 0.71; 95% CI 0.29-1.70).
  
  
  CONCLUSIONS
  Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged≤70 years with ≥30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.
authors: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland. pekkalop@paju.oulu.fi
authors: Pekka
authors: P
authors: Löppönen
authors: Sami
authors: S
authors: Tetri
authors: Seppo
authors: S
authors: Juvela
authors: Juha
authors: J
authors: Huhtakangas
authors: Pertti
authors: P
authors: Saloheimo
authors: Michaela K
authors: MK
authors: Bode
authors: John
authors: J
authors: Koivukangas
authors: Matti
authors: M
authors: Hillbom
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D016017:Odds Ratio; D011153:Population; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014207:Trephining; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Hematoma evacuation; Intracerebral hemorrhage; Mortality; Outcome; Survival