Skip to main content

Advertisement

SpringerLink
Log in

Trends in Surgical Management and Mortality of Intracerebral Hemorrhage in the United States Before and After the STICH Trial

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

The Surgical Trial in Intracerebral Hemorrhage (STICH) showed no overall benefit from early surgery compared with initial conservative treatment for intracerebral hemorrhage (ICH). We hypothesized that the STICH trial findings would lead to a reduction in the rates of surgery for ICH in the United States. Using a national hospital database, we determined trends in surgery for ICH before and after publication of STICH. We also determined trends in ICH mortality during the study period.

Methods

We queried the Premier database for all ICH-related admissions (denominator) using the ICD-9 codes 431 and 432.9, and craniotomy (numerator) with CPT procedure codes 01.2, 01.24, 01.25, 01.31, 01.39, or 01.59, for fiscal years (FY) 2000—FY2008. Trends in craniotomy and ICH mortality were determined. Change over time was tested using logistic regression.

Results

During the study period, 107,590 ICH discharges were identified. A craniotomy procedure code was identified in 7,518 instances (7.0%). Surgical cases were younger and had lower mortality than non-surgical cases. Publication of the STICH trial did not significantly impact the rate of craniotomy for ICH in the United States (P = 0.15). Age-, race-, and gender-adjusted in-hospital ICH mortality decreased steadily during the study period (P < 0.001).

Conclusions

The rate of surgery among ICH discharges in the United States has remained stable in the past decade. While in-hospital ICH mortality decreased, controlled clinical trials are needed to determine which ICH patients would benefit from surgery, and if decreasing in-hospital mortality is associated with decreased longer term mortality and improved functional outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116(16):e391–413.

    Article  PubMed  Google Scholar 

  2. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008.

  3. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97.

    PubMed  Google Scholar 

  4. Kirkman MA, Mahattanakul W, Gregson BA, Mendelow AD. The effect of the results of the STICH trial on the management of spontaneous supratentorial intracerebral haemorrhage in Newcastle. Br J Neurosurg. 2008;22(6):739–46. Discussion 47.

    Article  CAS  PubMed  Google Scholar 

  5. Gregson BA, Mendelow AD. International variations in surgical practice for spontaneous intracerebral hemorrhage. Stroke. 2003;34(11):2593–7.

    Article  PubMed  Google Scholar 

  6. Andaluz N, Zuccarello M. Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database. J Neurosurg. 2009;110(3):403–10.

    Article  PubMed  Google Scholar 

  7. Adeoye O, Woo D, Haverbusch M, et al. Surgical management and case-fatality rates of intracerebral hemorrhage in 1988 and 2005. Neurosurgery. 2008;63(6):1113–7. Discussion 7–8.

    Article  PubMed  Google Scholar 

  8. Staffa JAGB. Outcome-based evaluation of a method for obtaining U.S. National estimates of inpatient drug utilization. Pharmacoepidemiol Drug Saf. 2003;12:S173.

    Google Scholar 

  9. Broderick J, Brott T, Tomsick T, Tew J, Duldner J, Huster G. Management of intracerebral hemorrhage in a large metropolitan population. Neurosurgery. 1994;34(5):882–7. Discussion 7.

    Article  CAS  PubMed  Google Scholar 

  10. Inagawa T, Ohbayashi N, Takechi A, Shibukawa M, Yahara K. Primary intracerebral hemorrhage in Izumo City, Japan: incidence rates and outcome in relation to the site of hemorrhage. Neurosurgery. 2003;53(6):1283–97. Discussion 97–98.

    Article  PubMed  Google Scholar 

  11. Morioka J, Fujii M, Kato S, et al. Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy. Surg Neurol. 2006;65(1):67–72. Discussion 3.

    Article  PubMed  Google Scholar 

  12. Flaherty ML, Haverbusch M, Sekar P, et al. Long-term mortality after intracerebral hemorrhage. Neurology. 2006;66(8):1182–6.

    Article  CAS  PubMed  Google Scholar 

  13. Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29(3):635–40.

    Article  CAS  PubMed  Google Scholar 

  14. Suarez JI, Zaidat OO, Suri MF, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med. 2004;32(11):2311–7.

    PubMed  Google Scholar 

  15. Alberts MJ, Latchaw RE, Selman WR, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36(7):1597–616.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by AAMC Grant MM-0971-07/07.

Author information

Authors and Affiliations

  1. Departments of Emergency Medicine, UC Neuroscience Institute, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0769, Cincinnati, OH, 45267-0525, USA

    Opeolu Adeoye

  2. Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA

    Opeolu Adeoye, Andrew Ringer & Mario Zuccarello

  3. Division of Neurocritical Care, University of Cincinnati, Cincinnati, OH, USA

    Opeolu Adeoye

  4. Cincinnati Children’s Environmental Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Richard Hornung

  5. Department of Neurology, University of Cincinnati, Cincinnati, OH, USA

    Pooja Khatri & Dawn Kleindorfer

Authors
  1. Opeolu Adeoye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Ringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Hornung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pooja Khatri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Zuccarello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dawn Kleindorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Opeolu Adeoye.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adeoye, O., Ringer, A., Hornung, R. et al. Trends in Surgical Management and Mortality of Intracerebral Hemorrhage in the United States Before and After the STICH Trial. Neurocrit Care 13, 82–86 (2010). https://doi.org/10.1007/s12028-010-9351-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-010-9351-4

Keywords

Search

Navigation