Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

Kuramatsu J, Biffi A, Gerner S, Sembill J, Sprügel M, Leasure A, Sansing L, Matouk C, Falcone GJ, Endres M, Haeusler KG, Sobesky J, Schurig J, Zweynert S, Bauer M, Vajkoczy P, Ringleb PA, Purrucker J, Rizos T, Volkmann J, Müllges W, Kraft P, Schubert AL, Erbguth F, Nueckel M, Schellinger PD, Glahn J, Knappe UJ, Fink GR, Dohmen C, Stetefeld H, Fisse AL, Minnerup J, Hagemann G, Rakers F, Reichmann H, Schneider H, Rahmig J, Ludolph AC, Stösser S, Neugebauer H, Röther J, Michels P, Schwarz M, Reimann G, Bäzner H, Schwert H, Claßen J, Michalski D, Grau A, Palm F, Urbanek C, Wöhrle JC, Alshammari F, Horn M, Bahner D, Witte OW, Günther A, Hamann GF, Hagen M, Röder S, Lücking H, Dörfler A, Testai FD, Woo D, Schwab S, Sheth KN, Huttner H (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 322

Pages Range: 1392-1403

Journal Issue: 14

DOI: 10.1001/jama.2019.13014

Abstract

Importance: The association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. 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.

Authors with CRIS profile

Involved external institutions

Charité - Universitätsmedizin Berlin Germany (DE) Westfälische Wilhelms-Universität (WWU) Münster Germany (DE) Klinikum Bad Hersfeld GmbH Germany (DE) Bezirkskrankenhaus Günzburg Germany (DE) Johannes Wesling Klinikum Minden Germany (DE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Universität Ulm Germany (DE) Gemeinschaftsklinikum Mittelrhein Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE) Technische Universität Dresden Germany (DE) Universität zu Köln Germany (DE) Klinikum Dortmund Germany (DE) HELIOS Kliniken Germany (DE) Klinikum Stuttgart Germany (DE) Universität Leipzig Germany (DE) University of Illinois College of Medicine United States (USA) (US) Yale University United States (USA) (US) Friedrich-Schiller-Universität Jena Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Massachusetts General Hospital United States (USA) (US) University of Cincinnati United States (USA) (US) Klinikum Nürnberg Germany (DE) Asklepios Klinik Altona Germany (DE)

How to cite

APA:

Kuramatsu, J., Biffi, A., Gerner, S., Sembill, J., Sprügel, M., Leasure, A.,... Huttner, H. (2019). Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage. Journal of the American Medical Association, 322(14), 1392-1403. https://doi.org/10.1001/jama.2019.13014

MLA:

Kuramatsu, Joji, et al. "Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage." Journal of the American Medical Association 322.14 (2019): 1392-1403.

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