Article
Early and late clinical outcome after decompressive craniectomy in patients with malignant brain infarction
Frühes und spätes klinisches Outcome nach dekompressive Kraniektomie bei Patienten mit malignem Hirninfarkt
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Authors
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Marco Stein
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Inga Sünkeler
- BDH Klinik, Neurologie, Braunfels, Deutschland
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Malgorzata Kolodziej
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Karsten Schöller
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Björn Misselwitz
- Qualitätssicherungsstelle Hessen, Eschborn, Deutschland
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Eberhard Uhl
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Decompressive craniectomy (DC) is a life-saving procedure in patients with malignant brain infarction (MBI). However, population-based data for outcome after acute care and early neurorehabilitation (ENR) has not been systematically analyzed. Aim of the current study was to evaluate the clinical outcome after DC for MBI based on a prospective stroke and rehabilitation registry.
Methods: Mortality and functional outcome was analyzed for patients that underwent DC for MBI between September 2015 and December 2017 in the state of Hesse, Germany. The data of patients with DC recorded in a prospective hospital-based stroke registry were matched to a prospective rehabilitation database of the entire State of Hesse, Germany. Favorable Outcome (FO) at the end of ENR was defined as modified Rankin scale 0-3. Cutoff values for age were calculated by receiver operating curve analysis.
Results: A total of 246 patients with DC were identified. Intra-hospital mortality was 10.2% (n=25). 1 patient (0.4%) was discharged to a nursing home directly after acute care. A positive match with ENR data was found in 157 (71.4%) of the remaining survivors. Median follow up time was 107 (IQR: 41.5–283) days. FO was observed in 19.8% (n=31) of the patients at the end of ENR. Mortality during ENR was 7.6% (n=12). The remaining 144 patients were discharged home with amateur support, home with professional support, other rehabilitation clinic, acute care clinic, or nursing home in 7.6%, 9.7%, 43.1%, 19.4%, and 20.1%, respectively. At the end of ENR only 1 patient was discharged home with an independent status. Mean age during ENR was 64.3±13.2 years. We calculated an age cutoff of 55 years for FO after DCI (AUC: 0.690, CI: 0.611–0.761; Youdens index: 0.35). At the end of ENR 17.5% of survivors ≥55 years had an FO compared to 40.6% of the survivors <55 years (P=0.007). In very old patients (≥80 years, n=18) no FO was observed.
Conclusion: Fusion of acute and rehabilitation data provides important outcome data for stroke patients. Outcome was significantly worse in patients ≥55 years of age following DC for MBI. Therefore, DC for MBI in the very old remains questionable.
