title: Decompressive Craniectomy in Conjunction With Evacuation of Intracranial Hemorrhagic Lesions Is Associated With Worse Outcomes in Elderly Patients With Traumatic Brain Injury: A Propensity Score Analysis.
abstract: BACKGROUND
  When it comes to evacuating intracranial hemorrhagic lesions in patients with traumatic brain injury (TBI), neurosurgeons perform either a craniotomy or a decompressive craniectomy (DC). The aim of the present study was to estimate the impact of DC on outcomes in elderly patients.
  
  
  METHODS
  This retrospective cohort study, conducted in a neurosurgical institute in Japan from April 2009 to June 2014, included 91 consecutive patients with TBI (aged 60 years or older) who underwent evacuation of intracranial hemorrhagic lesions. Patients were divided into 2 groups: craniotomy only or DC. We set the primary endpoint as an unfavorable outcome (death or vegetative state), as evaluated on the Glasgow Outcome Scale at 6 months after injury. The secondary endpoints included existence of delayed hemorrhage and occurrence of hydrocephalus requiring shunt placement. The inverse probability of treatment weighting method was used to develop a propensity model to adjust for baseline imbalances between groups.
  
  
  RESULTS
  The DC group exhibited greater severity both in clinical and computed tomography findings according to baseline characteristics. After we adjusted for these differences by inverse probability of treatment weighting using the propensity score, DC was significantly associated with unfavorable outcomes (adjusted odds ratio, 8.00; 95% confidential interval, 2.30-27.84; P = 0.002) and delayed hemorrhage (adjusted odds ratio, 13.42; 95% confidential interval, 1.52-118.89; P = 0.022). There was no significant difference in the occurrence of hydrocephalus requiring shunt placement.
  
  
  CONCLUSIONS
  DC in conjunction with evacuation of intracranial hemorrhagic lesions was associated with worse functional outcome in elderly patients with TBI.
authors: Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan; Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan. Electronic address: ogmc.dmat.t.kinoshita@gmail.com.
authors: Takahiro
authors: T
authors: Kinoshita
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Kazuhisa
authors: K
authors: Yoshiya
authors: Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan.
authors: Yasunori
authors: Y
authors: Fujimoto
authors: Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan.
authors: Ryuichiro
authors: R
authors: Kajikawa
authors: Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan.
authors: Takeyuki
authors: T
authors: Kiguchi
authors: Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan; Department of Medical Innovation, Osaka University Hospital, Suita, Japan.
authors: Masahiko
authors: M
authors: Hara
authors: Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan.
authors: Akatsuki
authors: A
authors: Wakayama
authors: Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Toshiki
authors: T
authors: Yoshimine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007564:Japan; D008297:Male; D016017:Odds Ratio; D057216:Propensity Score; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Decompressive craniectomy; Elderly; Inverse probability of treatment weighting; Propensity score analysis; Traumatic brain injury