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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Decompressive craniectomy in elderly patients after severe traumatic brain injury

Dekompressive Hemikraniektomie in der Behandlung der älteren Patienten nach schwerem Schädel-Hirn-Trauma

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  • presenting/speaker Andrej Pala - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland
  • Stephanie Jesuthasan - Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
  • Franziska Schiller - Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
  • Dieter Woischneck - Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
  • Benjamin Mayer - Universitätsklinikum Ulm, Epidemiologie, Ulm, Deutschland
  • Ralph König - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland
  • Christian Rainer Wirtz - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland
  • Thomas Kapapa - Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV287

doi: 10.3205/22dgnc278, urn:nbn:de:0183-22dgnc2783

Published: May 25, 2022

© 2022 Pala et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The proportion of elderly patients >65 as well as the incidence of traumatic brain injury (TBI) in this age group are increasing. We have evaluated and compared the outcome after traumatic brain injury (TBI) and decompressive craniectomy (DC) in patients aged ≤65 years versus patients aged >65 years.

Methods: Retrospective, descriptive, observational study, was performed including 156 patients who underwent DC between 2005 and 2015 at our department. The cohort was stratified according to age (≤65 years) and (>65 years) in two groups and additionally divided in two subgroups: 66 to ≤74 years and ≥75 years. The Glasgow Outcome Scale (GOS) was used for functional assessment at discharge, and 3 and 12 months after DC. A favourable outcome was defined as GOS I-III. Significance was established as p≤0.05.

Results: Out of 156 patients, mortality rate at discharge was 27.6%. An unfavourable outcome at discharge was found in 87.2%, in 72% after 3 months and in 68.3% after 12 months. Statistically significant benefit for younger patients (≤65) was calculated after 3 (p=0.008) and 12 (p=0.001) months. A subgroup analysis of the older patients (> 65 years) did not reveal any significant differences. Mortality in this subgroup was 53 % after 12 months and a favourable outcome was noted in 13%. Moreover, more than one third was dependent on crucial support in everyday activities. Age (OR 0.231, p=0.005), time between trauma and surgery (hours, OR 1.026, p=0.011) and duration of artificial ventilation (OR 0.992, p=0.002) showed significant influence on outcome. Furthermore, thresholds for unfavourable outcome according to our data 52 years of age, GCS = 10 and DC performed 1 hour after TBI.

Conclusion: Based on our results, elderly patients >65 years are rarely independent after DC and mostly need substantial support in everyday life activities. Nevertheless, more than one fourth of patients achieved a good clinical outcome after 12 months. This aspect should be considered during counselling of the family and patients who potentially need DC after TBI.