Early neurosurgery tied to better survival in spontaneous haemorrhagic stroke

Neurosurgery performed 2–4 hours after presenting to the emergency department (ED) seems to result in better survival outcomes in patients with spontaneous haemorrhagic stroke, reports a recent study.

Researchers conducted a nationwide cross-sectional analysis of 2,602 patients (median age 61 years, 51.5 percent men) who presented to the ED for spontaneous haemorrhagic stroke and received neurosurgery within 12 hours. Majority of cases had intracranial haemorrhage (78.6 percent), followed by subarachnoid (15.8 percent) and mixed (5.6 percent) haemorrhage.

Most patients underwent surgery 2–4 hours after ED presentation and were designated as the early group (n=1,093; 42.0 percent); meanwhile, 525 (20.2 percent) and 984 (37.8 percent) received neurosurgery 0–2 hours and 4–12 hours after ED visit and were designated as the ultra-early and late groups, respectively.

Multivariable logistic regression analysis found that the odds of in-hospital mortality was more than 20 percent lower in the early vs late group (adjusted odds ratio [OR], 0.78, 95 percent confidence interval [CI], 0.63–0.96), though no such effect was reported for ultra-early surgery (adjusted OR, 0.90, 95 percent CI, 0.69–1.16).

Timing of surgery had no significant impact on risk of reoperation.

Further analysis at 30-minute intervals revealed that the optimal cutoff for neurosurgery was 4.5 hours, at which the odds of in-hospital mortality was lowest (OR, 0.80, 95 percent CI, 0.66–0.98).

“Early surgery was associated with favourable survival outcomes in patients with spontaneous haemorrhagic stroke who needed emergency neurosurgery,” the researchers said. “Determining surgical indications and developing standard protocols for those patients are needed to improve survival outcomes for patients facing this fatal disease.”