title: Nationwide study of decompressive surgery for malignant supratentorial infarction in the Czech Republic: utilization and outcome predictors. Clinical article.
abstract: OBJECTIVE
  Decompressive surgery within 48 hours in patients younger than 60 years of age reduces mortality and morbidity from malignant supratentorial infarction. The goal of this study was to characterize the utilization of decompressive surgery in the Czech Republic in 2006.
  
  
  METHODS
  This nationwide study was undertaken from September to December 2007 using a questionnaire sent to all neurosurgery departments in the Czech Republic. Diagnosis of brain infarction and decompressive surgery was based on discharge codes. Patient data were retrieved from hospital charts. Favorable outcome was defined as a modified Rankin scale score ≤4 on the day of discharge from the hospital.
  
  
  RESULTS
  Data were obtained from 15 of the 16 neurosurgery departments in the Czech Republic (94%) and from 39 patients (11 female [28%]). The average patient age was 52 +/-14 years (11 patients > 60), median time to surgery was 48 hours (interquartile range [IQR] 26-67 hours; 15 patients > 48 hours), median National Institutes of Health Stroke Scale score was 22 (IQR 16-30), median infarct volume was 341 cm³ (IQR 243-375 cm³), mean shift from the midline was 9.9 +/- 4.1 mm, median duration of hospitalization was 19 days (IQR 13-30 days), and mean bone flap surface area was 75 cm² (IQR 70-97 cm²). A favorable outcome was achieved in 19 patients (49%). The median number of procedures per site in 2006 was 1.5 (range 0-13 procedures). Five sites (31%) serving one-third of the entire population did not perform any decompressive surgery. No variable was a significant predictor of outcome in a multiple regression model.
  
  
  CONCLUSIONS
  In 2006 decompressive surgery was underutilized and occurred late in the clinical course in the Czech Republic. Revision of national guidelines is necessary to incorporate the latest data and ensure that the patients who can benefit most receive treatment.
authors.affiliation: Neurology, Neurosurgery, and Radiology Department, Faculty Hospital, Ostrava, Czech Republic. michal.bar@fno.cz
authors.forename: Michal
authors.initials: M
authors.lastname: Bar
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulik
authors.forename: David
authors.initials: D
authors.lastname: Skoloudík
authors.forename: Daniel
authors.initials: D
authors.lastname: Czerny
authors.forename: Radim
authors.initials: R
authors.lastname: Lipina
authors.forename: Lukas
authors.initials: L
authors.lastname: Klecka
authors.forename: Vilem
authors.initials: V
authors.lastname: Juran
authors.forename: Jan
authors.initials: J
authors.lastname: Mracek
authors.forename: Denisa
authors.initials: D
authors.lastname: Vondrácová
authors.forename: Lumir
authors.initials: L
authors.lastname: Hrabalek
authors.forename: Richard
authors.initials: R
authors.lastname: Brzezny
authors.forename: Jan
authors.initials: J
authors.lastname: Dienelt
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D018153:Czech Republic / Q000453:epidemiology; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015173:Supratentorial Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome