Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals.
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.Patient discharges with ischemic stroke as the primary diagnosis un...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3237608?pdf=render |
| _version_ | 1811218825741336576 |
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| author | Brian P Walcott Elena V Kuklina Brian V Nahed Mary G George Kristopher T Kahle J Marc Simard Wael F Asaad Jean-Valery C E Coumans |
| author_facet | Brian P Walcott Elena V Kuklina Brian V Nahed Mary G George Kristopher T Kahle J Marc Simard Wael F Asaad Jean-Valery C E Coumans |
| author_sort | Brian P Walcott |
| collection | DOAJ |
| description | 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.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.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.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. |
| first_indexed | 2024-04-12T07:16:00Z |
| format | Article |
| id | doaj.art-564c57baaf88487c8cb7f9633efd43f2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T07:16:00Z |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-564c57baaf88487c8cb7f9633efd43f22022-12-22T03:42:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-01612e2919310.1371/journal.pone.0029193Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals.Brian P WalcottElena V KuklinaBrian V NahedMary G GeorgeKristopher T KahleJ Marc SimardWael F AsaadJean-Valery C E CoumansRandomized 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.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.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.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.http://europepmc.org/articles/PMC3237608?pdf=render |
| spellingShingle | Brian P Walcott Elena V Kuklina Brian V Nahed Mary G George Kristopher T Kahle J Marc Simard Wael F Asaad Jean-Valery C E Coumans Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS ONE |
| 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 |
| url | http://europepmc.org/articles/PMC3237608?pdf=render |
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