Surgical Evacuation versus Conservative Treatment in Elderly Patients with Basal Ganglia Hemorrhage: A Propensity Score Matched Study

Boonlert Mitmuang¹

Affiliation : ¹ Division of Neurosurgery, Department of Surgery, Chumphon Khet Udomsakdi Hospital, Chumphon, Thailand

Objective: To study and compare the efficacy of surgery and conservative treatment in elderly patients with spontaneous basal ganglia hemorrhage (BGH) using a propensity score matched study.
Materials and Methods: Efficacy research with a retrospective cohort study was conducted by reviewing patients aged 60 and older treated with surgical evacuation or conservative treatment between January 2017 and January 2022. To compare the proportion of favorable outcomes (mRS 0 to 3) at six months, rate of the 30-day mortality, ratio of hospital-acquired pneumonia, and length of hospital stay. Propensity score matching was applied to adjust the confounding factors.
Results: Total of 366 patients were included in the present study. Of these, 204 were matched for analyses (102 with surgical evacuation and 102 with conservative treatment). There was no significant difference in the proportion of favorable outcomes between both groups (adjusted risk difference 11.2%, 95% CI –0.03 to 0.25, p=0.115). Surgical evacuation showed significantly lower rates of mortality within 30 days (adjusted risk difference –16.9%, 95% CI –0.3 to –0.1, p=0.001). The proportion of hospital-acquired pneumonia and the length of hospital stay showed no significant difference between both groups (adjusted risk difference –3.8%, 95% CI –0.1 to 0.04, p=0.369, and mean difference –0.9, 95% CI–2.7 to 1.0, p=0.358, respectively).
Conclusion: Surgical evacuation of spontaneous BGH in the elderly patients could reduce the 30-day mortality. However, it did not demonstrate any quantifiable improvement in functional outcome at 6 months, or hospital-acquired pneumonia, and the length of hospital stay.

Received 11 April 2022 | Revised 8 June 2022 | Accepted 8 July 2022
DOI: 10.35755/jmedassocthai.2022.09.13568

Keywords : Craniotomy; Conservative treatment; Basal ganglia hemorrhage; Elderly patients; Propensity score matched

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