Factors of postoperative mortality in stroke-related intracerebral hematoma located in supratentorial region

Objective: Acute cerebrovascular accidents remain a leading cause of mortality and disability. Supratentorial intracerebral hematomas are the most severe form of hemorrhagic stroke, and the effectiveness and optimal timing of their surgical treatment remain a subject of debate. The aim of the study was to identify independent factors influencing postoperative mortality in the surgical treatment of supratentorial intracerebral hematomas. Methods: A single-center retrospective cohort study was conducted. Data from 217 patients undergoing surgery for ICH at the National Hospital (2019–2024) were analyzed. Demographic, clinical (time to surgery, level of consciousness according to the Glasgow Coma Scale (GCS)), and neuroimaging (volume, location, midline displacement, and severity of intraventricular hemorrhage (IVH) according to the Graeb scale) parameters, surgery type, and recurrence were assessed. The primary endpoint was in-hospital mortality. Binary logistic regression analysis (LRA) was used to identify independent predictors of mortality. Results: Overall mortality was 21.7% (n=47). Multiple LRA revealed the following independent risk factors for postoperative mortality: age over 70 years (OR=4.1, 95%CI 1.8–9.4; p7 mm (OR=3.8, 95%CI 1.7–8.5; p=0.001), and IVH with Graeb score ≥5 (OR=3.2, 95%CI 1.4–7.3; p=0.006). Surgery performed within 1-3 days from hemorrhage onset was also associated with an increased mortality risk (OR=2.9, 95%CI 1.2-7.0; p=0.018) compared with surgery performed after 10 days. Hematoma recurrence was an extremely unfavorable prognostic factor. Conclusion: Postoperative mortality after supratentorial intracerebral hematomas is determined by a combination of independent factors: advanced age, profound depression of consciousness, significant brain herniation, and severe intraventricular hemorrhage. Optimization of patient selection for surgical treatment should take these prognostic markers into account. The identified association between higher mortality and surgery performed within 1-3 days requires further study, taking into account the initial severity of the patient's condition.