Comorbidity Burden and Early Postoperative Rebleeding After Supratentorial Intracerebral Hematoma Evacuation: A Retrospective Cohort Study

Background Early postoperative rebleeding after intracerebral hemorrhage (ICH) evacuation remains a highly consequential complication, associated with neurological deterioration and potential need for reintervention. Systemic patient factors—particularly multimorbidity, chronic alcohol use (often accompanied by liver disease), renal dysfunction, and anticoagulant therapy—may modify early bleeding risk. Aim To evaluate the association between comorbidity burden (0–1 vs multimorbidity ≥ 2 chronic conditions) and early postoperative rebleeding after ICH evacuation, and to discuss plausible mechanisms and clinical implications related to alcohol-related disease, hepatopathy, nephropathy, and anticoagulation. Methods Retrospective cohort analysis of 111 patients undergoing surgery for supratentorial ICH with the explicit goal of hematoma evacuation (conventional craniotomy, n = 76; endoscopic-assisted procedures, n = 35). Routine postoperative CT was performed within 6 hours and at 24 hours. Early rebleeding was assessed within 24 hours and defined as a new hyperdense component within the evacuated hematoma cavity and/or pericavitary surrounding brain after gross-total evacuation had been achieved or confirmed on early postoperative CT. Comorbidity burden was classified as 0–1 comorbidity versus multimorbidity (≥ 2 chronic conditions). Results Overall, 11/111 (9.9%) patients developed early postoperative rebleeding. Rebleeding rates did not differ significantly by surgical approach (7/76 [9.2%] conventional craniotomy vs 4/35 [11.4%] endoscopic-assisted; Fisher’s exact p = 0.739; OR 1.27, 95% CI 0.35–4.66). Comorbidity burden showed a strong association with rebleeding: 2/78 (2.6%) in the 0–1 comorbidity group versus 9/33 (27.3%) in the multimorbidity group (Fisher’s exact p = 0.00026), corresponding to an OR of 14.25 (95% CI 2.88–70.54) and a risk ratio of 10.64 for multimorbid versus low-burden patients. Conclusion Multimorbidity (≥ 2 chronic conditions) is a strong clinical marker of increased early postoperative rebleeding risk after ICH evacuation. These findings support intensified perioperative risk mitigation in high-burden patients, including strict hemodynamic control, metabolic stabilization, correction of coagulopathy, alcohol-withdrawal prophylaxis when relevant, and individualized antithrombotic management.