title: In-Hospital Mortality and Complication Rates in Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage in Central Europe: A Population-Based Study.
abstract: OBJECTIVE
  Secondary complications (SC) after intracerebral hemorrhage (ICH) can worsen outcome and are associated with early death. The purpose of the present study was to determine in-hospital mortality rates and SC after spontaneous ICH during acute care stay in a population-based cohort in central Europe.
  
  
  METHODS
  A prospective database of the State of Hesse, Germany, was screened for all patients with the primary diagnosis of spontaneous ICH (International statistical classification-10: I61.0-I61.9) between January 2007 and December 2012.
  
  
  RESULTS
  In the examined time period 10,029 patients with spontaneous ICH were identified. The cumulative rate of SC was 39.9% (1, 2, or ≥3 SC were documented in 25.0%, 10.1%, and 4.7%, respectively). The most common SC were pneumonia (15.1%), brain edema (6.5%), cardiac decompensation (5.9%), urogenital infection (5.5%), hydrocephalus (4.6%), epilepsy (3.4%), and rebleeding (3.4%). One, 2, or ≥3 SC were found in 2512 patients (25.0%), 1012 (10.1%), 473 (4.7%) patients, respectively. One SC was only a predictor of in-hospital mortality in conservatively treated patients (odds ratio [OR], 1.3; 95% confidence interval [CI] 1.2-1.5, P< 0.001). With an accumulation of SC to ≥3 the chance of in-hospital death increases for surgically (OR, 3.7, 95% CI 2.3-5.9; P< 0.001) and conservatively (OR, 3.0, 95% CI 2.3-3.9; P< 0.001) treated patients.
  
  
  CONCLUSIONS
  Surgical treatment of hematomas is associated with an increased rate of SC, but not with higher mortality rates compared with conservatively treated patients. The prevention of an accumulation of SC could lead to a decrease of in-hospital mortality after spontaneous ICH.
authors.affiliation: Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany. Electronic address: Marco.Stein@neuro.med.uni-giessen.de.
authors.forename: Marco
authors.initials: M
authors.lastname: Stein
authors.affiliation: Department of Neurology, Bezirkskrankenhaus Günzburg, Günzburg, Germany.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Hamann
authors.affiliation: Institute of Quality Assurance Hesse, Eschborn, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Uhl
authors.affiliation: Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Kolodziej
authors.affiliation: Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany.
authors.forename: Marcus H T
authors.initials: MHT
authors.lastname: Reinges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute care; Complications; Intracerebral hemorrhage; Mortality; Outcome