Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis.
BACKGROUND:Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching ho...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2016-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC4713228?pdf=render |
id |
doaj-1768a6853f354f44a999c55a6aac1905 |
---|---|
record_format |
Article |
spelling |
doaj-1768a6853f354f44a999c55a6aac19052020-11-25T02:46:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01111e014674710.1371/journal.pone.0146747Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis.Roberto Bezerra VitalPedro Tadao Hamamoto FilhoGustavo Jose LuvizuttoLuis Gustavo DucatiGabriel Pereira BragaHelio Rubens de Carvalho NunesFlavio Ramalho RomeroEliana Marisa GanemMarco Antonio ZaniniRodrigo BazanBACKGROUND:Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes. METHODS:A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age. RESULTS:The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30-11.74), whereas only 24% had mRS of 0-4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70-98.48). CONCLUSIONS:Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.http://europepmc.org/articles/PMC4713228?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Roberto Bezerra Vital Pedro Tadao Hamamoto Filho Gustavo Jose Luvizutto Luis Gustavo Ducati Gabriel Pereira Braga Helio Rubens de Carvalho Nunes Flavio Ramalho Romero Eliana Marisa Ganem Marco Antonio Zanini Rodrigo Bazan |
spellingShingle |
Roberto Bezerra Vital Pedro Tadao Hamamoto Filho Gustavo Jose Luvizutto Luis Gustavo Ducati Gabriel Pereira Braga Helio Rubens de Carvalho Nunes Flavio Ramalho Romero Eliana Marisa Ganem Marco Antonio Zanini Rodrigo Bazan Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. PLoS ONE |
author_facet |
Roberto Bezerra Vital Pedro Tadao Hamamoto Filho Gustavo Jose Luvizutto Luis Gustavo Ducati Gabriel Pereira Braga Helio Rubens de Carvalho Nunes Flavio Ramalho Romero Eliana Marisa Ganem Marco Antonio Zanini Rodrigo Bazan |
author_sort |
Roberto Bezerra Vital |
title |
Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. |
title_short |
Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. |
title_full |
Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. |
title_fullStr |
Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. |
title_full_unstemmed |
Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis. |
title_sort |
decompressive hemicraniectomy in a south american population--morbidity and outcomes analysis. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2016-01-01 |
description |
BACKGROUND:Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes. METHODS:A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age. RESULTS:The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30-11.74), whereas only 24% had mRS of 0-4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70-98.48). CONCLUSIONS:Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region. |
url |
http://europepmc.org/articles/PMC4713228?pdf=render |
work_keys_str_mv |
AT robertobezerravital decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT pedrotadaohamamotofilho decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT gustavojoseluvizutto decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT luisgustavoducati decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT gabrielpereirabraga decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT heliorubensdecarvalhonunes decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT flavioramalhoromero decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT elianamarisaganem decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT marcoantoniozanini decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis AT rodrigobazan decompressivehemicraniectomyinasouthamericanpopulationmorbidityandoutcomesanalysis |
_version_ |
1724757033065906176 |