title: Modified Rankin Scale and Short-Term Outcome in Cranial Neurosurgery: A Prospective and Unselected Cohort Study.
abstract: BACKGROUND
  The modified Rankin Scale (mRS) was developed to monitor functional recovery after stroke, but nowadays it is a treatment outcome measure in elective neurosurgery. Our objective was to study how mRS changes associate with short-term postoperative outcome.
  
  
  METHODS
  Preoperative, in-hospital, and 30-day mRS scores came from a prospective, consecutive and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 in Helsinki, Finland. Recorded data included subjective and objective postoperative in-hospital complications as well as changes in mRS score after surgery.
  
  
  RESULTS
  Minor or major complications were detectable in 46% of the patients. In-hospital and 30-day postoperative increases in mRS score were inconsistent; among patients with no complications, 17% had a greater mRS score at discharge and 24% at 30 days, whereas 28% of the patients with major complications showed no increase in mRS score at discharge. Of individual complications, only new or worsened hemiparesis, silent stroke, and pneumonia were associated with postoperative increase (>2) in mRS score after multivariable analysis. For mRS-score difference > 1 at discharge in detecting major complications (including mortality), sensitivity was 45% and specificity 94%.
  
  
  CONCLUSIONS
  The mRS changes after elective cranial neurosurgery are inconsistent. The mRS seems to represent functional changes, which do not necessarily associate with detected in-hospital complications.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: elina.reponen@hus.fi.
authors.forename: Elina
authors.initials: E
authors.lastname: Reponen
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Tuominen
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Miikka
authors.initials: M
authors.lastname: Korja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Craniotomy; Outcome; modified Rankin Scale