Decompressive Hemicraniectomy in a South American Population - Morbidity and Outcomes Analysis
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1371/journal.pone.0146747 http://hdl.handle.net/11449/161143 |
Resumo: | 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. |
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Decompressive Hemicraniectomy in a South American Population - Morbidity and Outcomes AnalysisBackground 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.Univ Estadual Paulista, Botucatu Med Sch, Dept Neurol Psychol & Psychiat, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Med Sch, Dept Publ Hlth Med, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Med Sch, Dept Anesthesiol, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Med Sch, Dept Neurol Psychol & Psychiat, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Med Sch, Dept Publ Hlth Med, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Med Sch, Dept Anesthesiol, Botucatu, SP, BrazilPublic Library ScienceUniversidade Estadual Paulista (Unesp)Vital, Roberto Bezerra [UNESP]Hamamoto Filho, Pedro Tadao [UNESP]Luvizutto, Gustavo Jose [UNESP]Ducati, Luis Gustavo [UNESP]Braga, Gabriel Pereira [UNESP]Carvalho Nunes, Helio Rubens de [UNESP]Romero, Flavio Ramalho [UNESP]Ganem, Eliana Marisa [UNESP]Zanini, Marco Antonio [UNESP]Bazan, Rodrigo [UNESP]2018-11-26T16:19:18Z2018-11-26T16:19:18Z2016-01-14info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article10application/pdfhttp://dx.doi.org/10.1371/journal.pone.0146747Plos One. San Francisco: Public Library Science, v. 11, n. 1, 10 p., 2016.1932-6203http://hdl.handle.net/11449/16114310.1371/journal.pone.0146747WOS:000368459300038WOS000368459300038.pdf2894975141895189Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengPlos One1,164info:eu-repo/semantics/openAccess2023-12-27T06:18:14Zoai:repositorio.unesp.br:11449/161143Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-12-27T06:18:14Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Decompressive Hemicraniectomy in a South American Population - Morbidity and Outcomes Analysis |
title |
Decompressive Hemicraniectomy in a South American Population - Morbidity and Outcomes Analysis |
spellingShingle |
Decompressive Hemicraniectomy in a South American Population - Morbidity and Outcomes Analysis Vital, Roberto Bezerra [UNESP] |
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 |
author |
Vital, Roberto Bezerra [UNESP] |
author_facet |
Vital, Roberto Bezerra [UNESP] Hamamoto Filho, Pedro Tadao [UNESP] Luvizutto, Gustavo Jose [UNESP] Ducati, Luis Gustavo [UNESP] Braga, Gabriel Pereira [UNESP] Carvalho Nunes, Helio Rubens de [UNESP] Romero, Flavio Ramalho [UNESP] Ganem, Eliana Marisa [UNESP] Zanini, Marco Antonio [UNESP] Bazan, Rodrigo [UNESP] |
author_role |
author |
author2 |
Hamamoto Filho, Pedro Tadao [UNESP] Luvizutto, Gustavo Jose [UNESP] Ducati, Luis Gustavo [UNESP] Braga, Gabriel Pereira [UNESP] Carvalho Nunes, Helio Rubens de [UNESP] Romero, Flavio Ramalho [UNESP] Ganem, Eliana Marisa [UNESP] Zanini, Marco Antonio [UNESP] Bazan, Rodrigo [UNESP] |
author2_role |
author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Vital, Roberto Bezerra [UNESP] Hamamoto Filho, Pedro Tadao [UNESP] Luvizutto, Gustavo Jose [UNESP] Ducati, Luis Gustavo [UNESP] Braga, Gabriel Pereira [UNESP] Carvalho Nunes, Helio Rubens de [UNESP] Romero, Flavio Ramalho [UNESP] Ganem, Eliana Marisa [UNESP] Zanini, Marco Antonio [UNESP] Bazan, Rodrigo [UNESP] |
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. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-01-14 2018-11-26T16:19:18Z 2018-11-26T16:19:18Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1371/journal.pone.0146747 Plos One. San Francisco: Public Library Science, v. 11, n. 1, 10 p., 2016. 1932-6203 http://hdl.handle.net/11449/161143 10.1371/journal.pone.0146747 WOS:000368459300038 WOS000368459300038.pdf 2894975141895189 |
url |
http://dx.doi.org/10.1371/journal.pone.0146747 http://hdl.handle.net/11449/161143 |
identifier_str_mv |
Plos One. San Francisco: Public Library Science, v. 11, n. 1, 10 p., 2016. 1932-6203 10.1371/journal.pone.0146747 WOS:000368459300038 WOS000368459300038.pdf 2894975141895189 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Plos One 1,164 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
10 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
publisher.none.fl_str_mv |
Public Library Science |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
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UNESP |
reponame_str |
Repositório Institucional da UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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1792962184917024768 |