Hormuzdiyar H Dasenbrock1,2,3, Faith C Robertson1,3, M Ali Aziz-Sultan1,2,3, Donovan Guittieres2, Rose Du1,2,3, Ian F Dunn1,2,3, William B Gormley4,5,6. 1. Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. 2. Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. 3. Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. 4. Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org. 5. Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org. 6. Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org.
Abstract
BACKGROUND: Decompressive hemicraniectomy (DHC) for space-occupying cerebral infarction in older adults remains controversial, and there are limited nationwide data evaluating the outcomes after craniectomy for stroke by patient age. METHODS: Patients who underwent DHC for ischemic stroke were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable logistic regression examined in-hospital mortality and a poor outcome (death, tracheostomy and gastrostomy, or discharge to institutional care). Covariates included year of admission, comorbidities, severity indices, and treatment variables (including the timing of decompression). RESULTS: Craniectomy was performed in 1673 patients: 62.4 % were aged 18-60 years, 20.6 % aged 61-70 years, and 17.0 % aged greater than 70 years. DHC was associated with reduced adjusted odds of in-hospital death compared with medical treatment alone among patients with cerebral edema in all age categories, including those older than 70 years (p ≤ 0.008). However, among surgical patients, the adjusted odds of mortality were significantly greater for patients aged 61-70 (30.7 %, p = 0.02) and greater than 70 years (34.5 %, p = 0.02), but not different for patients aged 51-60 (22.8 %), compared to those aged 18-50 years (19.7 %). The adjusted odds of a poor outcome also increased significantly with age, particularly for patients greater than 60 years. CONCLUSION: In this nationwide analysis, DHC was associated with reduced mortality regardless of patient age, including among those aged greater than 70 years. However, patients aged greater than 60 years treated surgically experienced higher odds of mortality (32.4 %), discharge to institutional care (47.1 %), and a poor outcome (77.0 %) compared with younger patients.
BACKGROUND: Decompressive hemicraniectomy (DHC) for space-occupying cerebral infarction in older adults remains controversial, and there are limited nationwide data evaluating the outcomes after craniectomy for stroke by patient age. METHODS:Patients who underwent DHC for ischemic stroke were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable logistic regression examined in-hospital mortality and a poor outcome (death, tracheostomy and gastrostomy, or discharge to institutional care). Covariates included year of admission, comorbidities, severity indices, and treatment variables (including the timing of decompression). RESULTS: Craniectomy was performed in 1673 patients: 62.4 % were aged 18-60 years, 20.6 % aged 61-70 years, and 17.0 % aged greater than 70 years. DHC was associated with reduced adjusted odds of in-hospital death compared with medical treatment alone among patients with cerebral edema in all age categories, including those older than 70 years (p ≤ 0.008). However, among surgical patients, the adjusted odds of mortality were significantly greater for patients aged 61-70 (30.7 %, p = 0.02) and greater than 70 years (34.5 %, p = 0.02), but not different for patients aged 51-60 (22.8 %), compared to those aged 18-50 years (19.7 %). The adjusted odds of a poor outcome also increased significantly with age, particularly for patients greater than 60 years. CONCLUSION: In this nationwide analysis, DHC was associated with reduced mortality regardless of patient age, including among those aged greater than 70 years. However, patients aged greater than 60 years treated surgically experienced higher odds of mortality (32.4 %), discharge to institutional care (47.1 %), and a poor outcome (77.0 %) compared with younger patients.
Authors: Arnold Cheung; Christopher K Telaghani; Jianli Wang; Qing Yang; Timothy J Mosher; Raymond K Reichwein; Kevin M Cockroft Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Dean B Kostov; Richard H Singleton; David Panczykowski; Hilal A Kanaan; Michael B Horowitz; Tudor Jovin; Brian T Jankowitz Journal: World Neurosurg Date: 2011-12-24 Impact factor: 2.104
Authors: Ralph Rahme; Richard Curry; Dawn Kleindorfer; Jane C Khoury; Andrew J Ringer; Brett M Kissela; Kathleen Alwell; Charles J Moomaw; Matthew L Flaherty; Pooja Khatri; Daniel Woo; Simona Ferioli; Joseph Broderick; Opeolu Adeoye Journal: Stroke Date: 2011-10-27 Impact factor: 7.914
Authors: Julia Flechsenhar; Johannes Woitzik; Klaus Zweckberger; Hemasse Amiri; Werner Hacke; Eric Jüttler Journal: J Clin Neurosci Date: 2012-11-09 Impact factor: 1.961
Authors: Eric Jüttler; Stefan Schwab; Peter Schmiedek; Andreas Unterberg; Michael Hennerici; Johannes Woitzik; Steffen Witte; Ekkehart Jenetzky; Werner Hacke Journal: Stroke Date: 2007-08-09 Impact factor: 7.914
Authors: Taco Goedemans; Dagmar Verbaan; Bert A Coert; Bertjan Kerklaan; René van den Berg; Jonathan M Coutinho; Tessa van Middelaar; Paul J Nederkoorn; W Peter Vandertop; Pepijn van den Munckhof Journal: Neurosurgery Date: 2020-03-01 Impact factor: 4.654