Impact of stereotactic hematoma evacuation on medical costs during the chronic period in patients with spontaneous putaminal hemorrhage: a randomized study.

OBJECTIVE: Stereotactic hematoma evacuation (SHE) has been reported to reduce mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic hematoma evacuation has not been widely accepted, however, as a standard therapy because its effect on functional outcome has been regarded as marginal and insufficient to justify the costs of surgery. We reassessed the value of SHE by analyzing its impact on chronic-period medical costs based on an original randomized study carried out by us. METHODS: In total, 490 patients were entered into the study. The degree of neurologic severity was defined on admission according to the neurologic grades (NGs) ranging from NG1 to NG5, adopted by the Japanese Cooperative Study on Stroke Surgery. The NG2 and 3 patients were randomized into 2 groups with different treatment protocols (group I, SHE; group II, conservative treatment). On the other hand, the NG1, 4, and 5 patients were excluded from the randomization because a large-scale retrospective study in Japan had revealed that surgical treatment in patients assigned to these NG grades does not improve functional outcome. Among the 490 patients, 248 were excluded and 242 were randomized strictly. The latter patients comprised 148 men and 94 women. Their ages ranged from 38 to 80 years (mean, 60.5 years). The medical costs for patient care were analyzed at 1 year after onset. RESULTS: As compared with group II, group I demonstrated a lower mortality and better recovery to functional independence in NG3 patients. As compared with group II, group I revealed lower costs at 1 year after hemorrhage in NG2 patients, probably reflecting reduced neurologic deficits brought about by the SHE, and approximately the same costs in NG3 patients. CONCLUSION: Stereotactic hematoma evacuation is clearly of value from the medicoeconomical point of view in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but open to weak stimuli (NG2) or strong stimuli (NG3) on admission.

Impact of stereotactic hematoma evacuation on activities of daily living during the chronic period following spontaneous putaminal hemorrhage: a randomized study.

OBJECT: Stereotactic evacuation of hematoma has been reported to reduce the incidence of mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic evacuation of hematoma has not been widely accepted as a standard therapy, however, because its effect on functional outcome has been regarded as marginal and there have been no randomized trials with sufficient statistical power to quantify the benefits of this procedure. The authors reassessed the value of stereotactic evacuation of hematoma by analyzing its impact on activities of living during the chronic period following spontaneous putaminal hemorrhage in a randomized study. METHODS: Four hundred ninety patients were entered into the study. The severity of their hemorrhages was graded neurologically on admission (neurological grades: 1, eyes are open; 2, eyes are closed but open to weak stimuli; 3, eyes are closed but open to strong stimuli; 4, eyes do not open but extremities move to stimuli; and 5, eyes do not open and extremities do not move to stimuli). Patients with Grade 2 and those with Grade 3 were randomized into two groups with different treatment protocols (Group I, stereotactic evacuation of the hematoma; and Group II, conservative treatment). Patients assigned neurological Grade 4 or 5 were excluded from the study because a large-scale retrospective study in Japan revealed that surgical treatment in patients assigned to these neurological grades does not improve functional outcome. Among the 490 patients, 242 were randomized strictly. This patient population comprised 148 men and 94 women ranging in age from 38 to 80 years (mean 60.5 years). Compared with Group II, Group I treatment resulted in a lower mortality rate and better recovery to functional independence in patients with neurological Grade 3. In patients with Grade 2, Group I treatment contributed to a better recovery of functional outcome and a lower mortality rate, but the difference was not significant. Multivariate analysis confirmed that stereotactic evacuation of the hematoma was contributory to a better recovery in functional outcome. CONCLUSIONS: Stereotactic evacuation of hematoma is clearly of value in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but will open in response to strong stimuli (neurological Grade 3) on admission.