Elina Reponen1, Hanna Tuominen2, Juha Hernesniemi3, Miikka Korja3. 1. Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: elina.reponen@hus.fi. 2. Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 3. Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Abstract
BACKGROUND: The modified Rankin Scale (mRS) was developed to monitor functional recovery after stroke, but nowadays it is a treatment outcome measure in elective neurosurgery. Our objective was to study how mRS changes associate with short-term postoperative outcome. METHODS: Preoperative, in-hospital, and 30-day mRS scores came from a prospective, consecutive and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 in Helsinki, Finland. Recorded data included subjective and objective postoperative in-hospital complications as well as changes in mRS score after surgery. RESULTS: Minor or major complications were detectable in 46% of the patients. In-hospital and 30-day postoperative increases in mRS score were inconsistent; among patients with no complications, 17% had a greater mRS score at discharge and 24% at 30 days, whereas 28% of the patients with major complications showed no increase in mRS score at discharge. Of individual complications, only new or worsened hemiparesis, silent stroke, and pneumonia were associated with postoperative increase (>2) in mRS score after multivariable analysis. For mRS-score difference > 1 at discharge in detecting major complications (including mortality), sensitivity was 45% and specificity 94%. CONCLUSIONS: The mRS changes after elective cranial neurosurgery are inconsistent. The mRS seems to represent functional changes, which do not necessarily associate with detected in-hospital complications.
BACKGROUND: The modified Rankin Scale (mRS) was developed to monitor functional recovery after stroke, but nowadays it is a treatment outcome measure in elective neurosurgery. Our objective was to study how mRS changes associate with short-term postoperative outcome. METHODS: Preoperative, in-hospital, and 30-day mRS scores came from a prospective, consecutive and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 in Helsinki, Finland. Recorded data included subjective and objective postoperative in-hospital complications as well as changes in mRS score after surgery. RESULTS: Minor or major complications were detectable in 46% of the patients. In-hospital and 30-day postoperative increases in mRS score were inconsistent; among patients with no complications, 17% had a greater mRS score at discharge and 24% at 30 days, whereas 28% of the patients with major complications showed no increase in mRS score at discharge. Of individual complications, only new or worsened hemiparesis, silent stroke, and pneumonia were associated with postoperative increase (>2) in mRS score after multivariable analysis. For mRS-score difference > 1 at discharge in detecting major complications (including mortality), sensitivity was 45% and specificity 94%. CONCLUSIONS: The mRS changes after elective cranial neurosurgery are inconsistent. The mRS seems to represent functional changes, which do not necessarily associate with detected in-hospital complications.
Authors: Stanisław Krajewski; Jacek Furtak; Monika Zawadka-Kunikowska; Michał Kachelski; Marcin Birski; Marek Harat Journal: Int J Environ Res Public Health Date: 2022-02-17 Impact factor: 3.390
Authors: Stanisław Krajewski; Jacek Furtak; Monika Zawadka-Kunikowska; Michał Kachelski; Marcin Birski; Marek Harat Journal: Int J Environ Res Public Health Date: 2022-08-31 Impact factor: 4.614