Abstract 46: Minimally Invasive Surgery is Associated With Lower Mortality After Spontaneous Intracerebral Hemorrhage in the Get With the Guidelines Registry
Bibliographic record
Abstract
Introduction: The efficacy of emergent minimally invasive surgery (MIS) in improving outcomes after non-traumatic intracerebral hemorrhage (ICH) is unclear, with two randomized clinical trials (MISTIE III and ENRICH) showing conflicting results. We therefore sought to evaluate the association of MIS for ICH with outcomes in a real-world, nationally representative cohort. Methods: We performed a retrospective cohort study of patients with ICH in the Get With The Guidelines-Stroke registry, between 2011 and 2021. Patients who underwent open craniotomy/craniectomy and those transferred to another hospital were excluded. The study exposure was MIS, defined as a composite of stereotactic surgical evacuation and endoscopic surgical evacuation. The primary outcome was in-hospital mortality. In the primary analysis, we matched patients who underwent MIS with medically managed patients in a 1:1 manner on age, sex, race, NIH Stroke Scale, prior antithrombotic therapy, and external ventricular drain use. Logistic regression was used while adjusting for withdrawal of care. In secondary analyses, stereotactic and endoscopic surgical approaches were analyzed separately. Results: Among 555,964 patients with ICH, MIS was performed in 703 patients (330 had stereotactic surgery; 391 had endoscopic surgery). The matched cohort included 485 patients in each group. Median time to surgery was 1 day (IQR, 1-2). In-hospital deaths occurred in 63 (13%) with MIS and 96 (20%) without surgery. Medically managed patients had more vascular comorbidities such as hypertension, diabetes, and prior stroke than those who underwent MIS. In regression analyses adjusted for withdrawal of care, MIS was associated with lower in-hospital mortality at discharge (aOR, 0.4; CI, 0.3-0.6). In secondary analyses, stereotactic surgery (aOR, 0.3; CI, 0.2-0.6) and endoscopic surgery (aOR, 0.6; CI, 0.3-0.9) were also independently associated with lower mortality. Conclusions: In a large heterogeneous US cohort of ICH patients, emergent MIS was associated with lower in-hospital mortality. Longer-term follow up data with ascertainment of functional outcomes may shed more light on the benefit of surgery after ICH.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".