title: Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis.
abstract: 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.
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Roberto Bezerra
authors.initials: RB
authors.lastname: Vital
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Pedro Tadao
authors.initials: PT
authors.lastname: Hamamoto Filho
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Gustavo Jose
authors.initials: GJ
authors.lastname: Luvizutto
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Luis Gustavo
authors.initials: LG
authors.lastname: Ducati
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Gabriel Pereira
authors.initials: GP
authors.lastname: Braga
authors.affiliation: Department of Public Health Medicine at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Helio Rubens de Carvalho
authors.initials: HR
authors.lastname: Nunes
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Flavio Ramalho
authors.initials: FR
authors.lastname: Romero
authors.affiliation: Department of Anesthesiology at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Eliana Marisa
authors.initials: EM
authors.lastname: Ganem
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Zanini
authors.affiliation: Department of Neurology, Psychology and Psychiatry at Botucatu Medical School, Univ Estadual Paulista, Botucatu, SP, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bazan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013020:South America; D020521:Stroke / Q000601:surgery*