Abstract
BACKGROUND: Spontaneous intracerebral hemorrhage (SICH), particularly hypertensive basal ganglia hemorrhage, is a severe stroke subtype associated with high mortality and disability. A substantial proportion of these patients require mechanical ventilation (MV), and prolonged MV (PMV) is associated with increased complications and worse outcomes. While certain clinical and radiological factors have been linked to PMV in general critical care or stroke populations, evidence specific to patients with hypertensive basal ganglia hemorrhage remains scarce, limiting early risk stratification. OBJECTIVE: To determine the incidence of PMV (≥14 days of MV) and identify independent predictors in postoperative patients with hypertensive basal ganglia SICH. METHODS: This retrospective cohort study (September 2019 to September 2025) included 173 consecutive adult patients with hypertensive basal ganglia SICH who underwent surgery and required postoperative MV. PMV was defined as MV lasting ≥14 days from intensive care unit (ICU) admission. Potential predictors were screened using univariate analyses and entered into multivariable logistic regression to identify independent predictors. Model discrimination and calibration were assessed. RESULTS: Among 173 postoperative patients with hypertensive basal ganglia hemorrhage requiring MV, PMV (≥14 days) occurred in 55 (31.8%). In multivariable logistic regression, older age (adjusted OR 1.05 per year, 95% CI 1.02-1.07), chronic kidney disease (adjusted OR 5.46, 95% CI 1.91-18.43), lower admission Glasgow Coma Scale (GCS) score (adjusted OR 0.82 per point, 95% CI 0.72-0.91), and intraoperative drainage catheter placement (adjusted OR 3.51, 95% CI 1.91-6.64) were independent predictors of PMV. A prediction model incorporating these variables showed moderate-to-good discrimination (AUC 0.779, 95% CI 0.702-0.856) and acceptable calibration. CONCLUSION: PMV (≥14 days) affected approximately one-third of critically ill postoperative patients with hypertensive basal ganglia hemorrhage. A model based on age, chronic kidney disease, admission GCS score, and intraoperative drainage catheter placement demonstrated moderate-to-good discrimination and acceptable calibration, and may support early postoperative risk stratification; external validation is warranted before routine clinical implementation.