Cargando…

Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals

OBJECT: Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database. METHODS: Patient discharges with ischemic stroke as the pr...

Descripción completa

Detalles Bibliográficos
Autores principales: Walcott, Brian P., Kuklina, Elena V., Nahed, Brian V., George, Mary G., Kahle, Kristopher T., Simard, J. Marc, Asaad, Wael F., Coumans, Jean-Valery C. E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237608/
https://www.ncbi.nlm.nih.gov/pubmed/22195021
http://dx.doi.org/10.1371/journal.pone.0029193
_version_ 1782218924328222720
author Walcott, Brian P.
Kuklina, Elena V.
Nahed, Brian V.
George, Mary G.
Kahle, Kristopher T.
Simard, J. Marc
Asaad, Wael F.
Coumans, Jean-Valery C. E.
author_facet Walcott, Brian P.
Kuklina, Elena V.
Nahed, Brian V.
George, Mary G.
Kahle, Kristopher T.
Simard, J. Marc
Asaad, Wael F.
Coumans, Jean-Valery C. E.
author_sort Walcott, Brian P.
collection PubMed
description OBJECT: Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database. METHODS: Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications. RESULTS: After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999–2000 to 14.46 in 2007–2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18–59 year old group was found to be 24%(p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered. CONCLUSIONS: Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure.
format Online
Article
Text
id pubmed-3237608
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-32376082011-12-22 Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals Walcott, Brian P. Kuklina, Elena V. Nahed, Brian V. George, Mary G. Kahle, Kristopher T. Simard, J. Marc Asaad, Wael F. Coumans, Jean-Valery C. E. PLoS One Research Article OBJECT: Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database. METHODS: Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications. RESULTS: After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999–2000 to 14.46 in 2007–2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18–59 year old group was found to be 24%(p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered. CONCLUSIONS: Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure. Public Library of Science 2011-12-14 /pmc/articles/PMC3237608/ /pubmed/22195021 http://dx.doi.org/10.1371/journal.pone.0029193 Text en Walcott et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Walcott, Brian P.
Kuklina, Elena V.
Nahed, Brian V.
George, Mary G.
Kahle, Kristopher T.
Simard, J. Marc
Asaad, Wael F.
Coumans, Jean-Valery C. E.
Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title_full Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title_fullStr Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title_full_unstemmed Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title_short Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals
title_sort craniectomy for malignant cerebral infarction: prevalence and outcomes in us hospitals
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237608/
https://www.ncbi.nlm.nih.gov/pubmed/22195021
http://dx.doi.org/10.1371/journal.pone.0029193
work_keys_str_mv AT walcottbrianp craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT kuklinaelenav craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT nahedbrianv craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT georgemaryg craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT kahlekristophert craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT simardjmarc craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT asaadwaelf craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals
AT coumansjeanvaleryce craniectomyformalignantcerebralinfarctionprevalenceandoutcomesinushospitals