Short-term surgical outcomes of spontaneous intracerebral hemorrhage in China from 2019 to 2021: a retrospective cohort study

Ye Li; Hongyi Yang; Lei Cao; Penghu Wei; Yuhong Liu; Tao Wang; Xue Wang; Xuesong Bai; Liqun Jiao; Hongqi Zhang; Yongzhi Shan; Longde Wang; Guoguang Zhao

doi:10.1016/j.lanwpc.2023.100870

Short-term surgical outcomes of spontaneous intracerebral hemorrhage in China from 2019 to 2021: a retrospective cohort study

Lancet Reg Health West Pac. 2023 Aug 4:39:100870. doi: 10.1016/j.lanwpc.2023.100870. eCollection 2023 Oct.

Authors

Ye Li¹, Hongyi Yang¹, Lei Cao², Penghu Wei^{1

3}, Yuhong Liu⁴, Tao Wang¹, Xue Wang⁵, Xuesong Bai¹, Liqun Jiao¹, Hongqi Zhang¹, Yongzhi Shan¹, Longde Wang^{2

6}, Guoguang Zhao^{1

3

7}

Affiliations

¹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100053, China.
² General Office of the Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China.
³ National Center for Neurological Disorders, Beijing 100053, China.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China.
⁵ Medical Library of Xuanwu Hospital, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁶ School of Public Health, Peking University, Beijing, China.
⁷ Beijing Municipal Geriatric Medical Research Center, Beijing 100053, China.

Abstract

Background: China has the highest prevalence of spontaneous intracerebral hemorrhage (sICH) worldwide. To date, no national-level report has revealed sICH surgical performance. We aimed to investigate the current status and short-term outcomes of patients who underwent surgical treatment for sICH between 2019 and 2021.

Methods: Data from 7451 patients undergoing sICH surgical treatment in China between 2019 and 2021, including demographic information, disease severity, surgical treatments for sICH, complications, and follow-up information, were retrieved from the Bigdata Observatory Platform for Stroke of China. Propensity score matching (PSM) was applied to balance the baseline characteristics. The surgical treatment performance on 3-month mortality and functional outcome were then explored by regression analysis. The influence of stroke center level and region on surgical performance was then explored.

Findings: The numbers of sICH patients undergoing open craniotomy (OC), cranial puncture (CP), decompressive craniectomy (DC) and endoscopic evacuation (EE) were 2404 (32.3%), 3030 (40.7%), 1700 (22.8%) and 317 (4.3%), respectively. The 3-month mortality rate was 20.2%. Among the surviving patients, the 3-month poor functional prognosis (mRS 3-5) rate was 46.5%. After PSM, regression analysis showed that DC was associated with a higher mortality risk (OR = 1.31, 95% CI 1.06-1.61) than OC. CP was associated with a lower risk of poor mRS scores than OC (OR = 0.84, 95% CI 0.70-1.01), especially in stroke prevention centers and specific regions.

Interpretation: Outcome improvements in Chinese sICH patients undergoing surgical treatment are worth expecting. Inconsistent surgical performance, especially functional outcome, affected by inhomogeneity of the hospital should be addressed.

Funding: This work was supported by the Beijing Hospitals Authority Youth Programme (QML20230804), the National Natural Science Foundation of China (81701796, 82030037, 81871009), Capital Health Research and Development of Special Fund (2020-2Z-2019), Science and Technology Innovation 2030-Major Project (2021ZD0201801), and the Translational and Application Project of Brain-inspired and Network Neuroscience on Brain Disorders (11000022T000000444685).

Keywords: Cranial puncture; Decompressive craniectomy; Endoscopic evacuation; Intracerebral hemorrhage; Open craniotomy; Propensity score matching; Short-term outcomes.