A337 Surgical versus conservative management of intracerebral hemorrhage: a meta-analysis and meta-regression of functional outcomes and mortality

<h3>Introduction</h3> The optimal treatment strategy for spontaneous intracerebral hemorrhage (ICH) remains a subject of ongoing debate. <h3>Aim of Study</h3> This meta-analysis and meta-regression aimed to compare surgical and conservative management regarding functional outcomes and mortality, while evaluating the impact of hemorrhage location on these endpoints. Method evaluating mortality in ICH patients was conducted. Primary outcomes included favorable functional outcome (modified Rankin Scale ≤3) and all-cause mortality. Meta-regression analyses explored the influence of hemorrhage location (deep brain, lobar, cerebellar) on both outcomes. Pooled risk ratios (RR) <b>were calculated using fixed- or random-effects models</b>, and heterogeneity was assessed via I² statistics. <h3>Results</h3> Surgical intervention significantly improved the likelihood of favorable functional outcomes compared to conservative treatment (RR: 1.38; 95% CI: 1.23–1.56; p &lt; 0.00001; I² = 13%). Mortality was reduced by 23% in the surgical group (RR: 0.77; 95% CI: 0.68–0.87; p &lt; 0.0001; I² = 30%). Meta-regression demonstrated no significant association between hemorrhage location and either functional outcome or mortality. While cerebellar hemorrhages showed the best recovery rates (68.2%) and lowest mortality (8.5%), deep brain hemorrhages were associated with poorer outcomes. <h3>Conclusion</h3> Surgical management of spontaneous ICH is associated with superior functional recovery and lower mortality compared to conservative treatment. Hemorrhage location did not significantly influence these outcomes, suggesting that patient-specific factors, surgical timing, and postoperative care may play a more decisive role in prognosis. These findings support the selective use of surgical intervention in ICH, emphasizing individualized treatment approaches. <h3>Conflict of Interest</h3> No