Objective: To compare surgical management and case-fatality rates of intracerebral hemorrhage (ICH) in 1988 and 2005.
Methods: We identified all adult residents (age, >or=18 years) from the 5-county Greater Cincinnati region who were hospitalized with ICH in 1988 and 2005. Demographics, severity of illness, ICH volume, ICH location, rates and timing of surgery, and 30-day case-fatality rate were compared between the groups.
Results: In 1988, 171 ICH patients (67 lobar, 80 deep cerebral, 10 brainstem, and 14 cerebellar) met the study criteria; in 2005, 259 ICH patients (91 lobar, 123 deep cerebral, 19 brainstem, and 26 cerebellar) met the study criteria. In 1988, 16% of the patients had surgical removal of their ICH versus 7% in 2005 (P = 0.003). In both 1988 and 2005, patients treated with surgery were younger (P < 0.001) and had a higher percentage of cerebellar hemorrhages than nonsurgical patients. The timing of surgery was similar in 1988 and 2005. In 1988, the 30-day case-fatality rate was 32% in surgical patients versus 50% in nonsurgical patients (P = 0.06). In 2005, the 30-day case-fatality rate was 16% (surgical) versus 45% (nonsurgical) (P = 0.02).
Conclusion: The frequency of surgery for ICH was lower in 2005 than in 1988, which may reflect the influence of recent clinical trial data showing no benefit for surgery rather than medical management. The ICH case-fatality rate was essentially the same in 1988 and 2005. Innovative clinical trials to improve ICH outcomes are warranted.