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Original research
Characterization of length of stay after minimally invasive endoscopic intracerebral hemorrhage evacuation
  1. Muhammad Ali,
  2. Colton Smith,
  3. Vikram Vasan,
  4. Margaret Downes,
  5. Braxton R Schuldt,
  6. Ian Odland,
  7. Muhammad Murtaza-Ali,
  8. Jonathan Dullea,
  9. Christina P Rossitto,
  10. Alexander J Schupper,
  11. Trevor Hardigan,
  12. Nek Asghar,
  13. John Liang,
  14. J Mocco,
  15. Christopher P Kellner
  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Muhammad Ali, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; muhammad.ali{at}


Background Minimally invasive evacuation may help ameliorate outcomes after intracerebral hemorrhage (ICH). However, hospital length of stay (LOS) post-evacuation is often long and costly.

Objective To examine factors associated with LOS in a large cohort of patients who underwent minimally invasive endoscopic evacuation.

Methods Patients presenting to a large health system with spontaneous supratentorial ICH qualified for minimally invasive endoscopic evacuation if they met the following inclusion criteria: age ≥18, premorbid modified Rankin Scale (mRS) score ≤3, hematoma volume ≥15 mL, and presenting National Institutes of Health Stroke Scale (NIHSS) score ≥6. Demographic, clinical, radiographic, and operative characteristics were included in a multivariate logistic regression for hospital and ICU LOS dichotomized into short and prolonged stay at 14 and 7 days, respectively.

Results Among 226 patients who underwent minimally invasive endoscopic evacuation, the median intensive care unit and hospital LOS were 8 (4–15) days and 16 (9–27) days, respectively. A greater extent of functional impairment on presentation (OR per NIHSS point 1.10 (95% CI 1.04 to 1.17), P=0.007), concurrent intraventricular hemorrhage (OR=2.46 (1.25 to 4.86), P=0.02), and deep origin (OR=per point 2.42 (1.21 to 4.83), P=0.01) were associated with prolonged hospital LOS. A longer delay from ictus to evacuation (OR per hour 1.02 (1.01 to 1.04), P=0.007) and longer procedure time (OR per hour 1.91 (1.26 to 2.89), P=0.002) were associated with prolonged ICU LOS. Prolonged hospital and ICU LOS were in turn longitudinally associated with a lower rate of discharge to acute rehabilitation (40% vs 70%, P<0.0001) and worse 6-month mRS outcomes (5 (4–6) vs 3 (2–4), P<0.0001).

Conclusions We present factors associated with prolonged LOS, which in turn was associated with poor long-term outcomes. Factors associated with LOS may help to inform patient and clinician expectations of recovery, guide protocols for clinical trials, and select suitable populations for minimally invasive endoscopic evacuation.

  • Hemorrhage
  • Stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @MuhammadM_Ali, @cprossitto, @chriskellnerMD

  • Contributors MA conceived the study, participated in the design of the study, collected data, carried out statistical analysis, drafted the manuscript, and is the guarantor for this study. CS, VV, MD, BRS, IO, MM-A, JD, CPR, AJS, TH, and NA collected data and critically revised manuscript. CPK, JM, and JL acquired data, supervised the study, participated in its design and coordination, and critically revised the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CPK receives research funding from Penumbra, Integra, Viz.AI, Minnetronix, Siemens, and Cerebrotech. JM is the president of the SNIS board of directors. He is also the principal investigator of the INVEST trial funded by Penumbra and has financial interest in Rebound Therapeutics. JM is also the principal investigator of the THERAPY (Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone), FEAT (Framing Eighteen Coils in Cerebral Aneurysms Trial), and BARREL (Reverse Medical Barrel Vascular Reconstruction Device (VRD) for Adjunctive Treatment Wide-Neck, Intracranial, Bifurcating/Branching Aneurysms) trials; he is the co-principal investigator of the COMPASS (A Comparison of Direct Aspiration Versus Stent Retriever as a First Approach), and POSITIVE (Perfusion Imaging Selection of Ischemic Stroke Patients for Endovascular Therapy) trials; he has financial interest in Rebound Therapeutics, Viseon, Cerebrotech, Endostream, Vastrax,Blink TBI, Serenity, NTI, Echovate,, RIST, NRT, Tulavi, CVAid, Imperative Care, Synchron, and Perflow.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.