Outcome of Ischemic Stroke Patients Following Decompressive Craniectomy: A Cohort Study
Mohammad Jamali1, Mahyar Noorollahi1, Ehsan Mohammad Hosseini1
1Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Decompressive craniectomy improves stroke outcomes, but older patients and those with comorbidities like COVID-19 face higher mortality. Higher GCS scores predict better survival and functional recovery after stroke surgery.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a vital intervention for managing severe stroke, reducing mortality and improving patient outcomes.
- Limited comprehensive studies exist on DC outcomes in regions like Iran, necessitating further investigation.
- Understanding stroke complications and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the effects and outcomes of decompressive craniectomy in stroke patients.
- To identify factors influencing survival and functional recovery post-DC.
- To provide data from a region with scarce comprehensive studies on DC outcomes.
Main Methods:
- A cohort study involving 144 adult ischemic stroke patients undergoing DC at Nemazi Hospital, Shiraz, Iran (2018-2020).
- Data collection included demographics, clinical history, and imaging; outcomes assessed via modified Rankin Scale (mRS), Glasgow Outcome Score Extended (GOSE), and Aphasia Severity Rating (ASR).
- Statistical analysis, including ordered logistic regression, was used to determine predictors of survival and functional outcomes.
Main Results:
- 55% of patients died within 6 months post-DC; older age (>60), prior stroke history, and COVID-19 infection were linked to decreased survival.
- Higher Glasgow Coma Scale (GCS) scores on admission correlated with increased survival probability (OR=1.199) and better functional outcomes (GOSE, mRS, ASR).
- Older patients (>60) demonstrated poorer outcomes on GOSE (OR=0.185) and worse outcomes on mRS (OR=5.182).
Conclusions:
- Comorbidities (COVID-19, prior stroke) and GCS scores are critical predictors of survival and functional outcomes after DC.
- Older patients exhibit higher mortality and poorer functional recovery, requiring careful clinical consideration.
- This study highlights the importance of pre-operative factors in predicting decompressive craniectomy success in stroke patients.
Background:
Decompressive craniectomy (DC) is effective in reducing mortality and improving outcomes in stroke patients. However, there is a need for a better understanding of the outcomes and complications of stroke, particularly in regions such as Iran, where comprehensive studies on DC outcomes are scarce. This study investigated the effects of DC in stroke patients.
Methods:
This cohort study was conducted at Nemazi Hospital in Shiraz, Iran, from 2018 to 2020. All patients aged over 18 years with ischemic stroke requiring DC were included using census sampling. Data on demographics, clinical history, and imaging findings were collected. Outcomes were assessed using the modified rankin scale (mRS), Glasgow outcome score extended (GOSE), and aphasia severity rating (ASR).
Results:
A total of 144 cerebral infarction patients underwent DC; 22 (15.3%) were lost to follow-up, and 67 (55%) of the remaining patients died either during hospitalization or within at least 6 months of follow-up. Patients over 60 years old (OR=0.152), those with a history of stroke (OR=0.227), and those with COVID-19 infection (OR=0.164) were associated with a decreased likelihood of survival. However, an increase in the Glasgow Coma Scale (GCS) score on admission was associated with an increased probability of survival (OR=1.199). The ordered logistic regression analysis showed that an increase in GCS score was associated with a higher probability of achieving better outcomes across all models: GOSE (OR=1.177), mRS (OR=0.839, with lower scores indicating better outcomes), and ASR (OR=1.354). The analysis showed that patients over 60 had a lower probability of achieving better outcomes in the GOSE model (OR=0.185) and were likely to have worse outcomes in the mRS model (OR=5.182).
Conclusion:
These findings underscored the critical role of comorbidities (such as COVID-19 and prior stroke) and GCS scores in predicting patient survival and functional outcomes following DC. In particular, the higher mortality rates and poorer functional outcomes observed in older patients highlighted the need for careful consideration in this age group.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:15Ischemic Stroke ll: Pathophysiology