Critical Age Affecting Functional Outcome after Decompressive Hemicraniectomy for Malignant Hemispheric Infarction.
OBJECTIVE
Although age already is known as a crucial factor affecting the functional outcome after a hemicraniectomy for malignant hemispheric infarction, previous studies have used arbitrary age cut-offs of 50, 60, or 70 years. Therefore, this study investigated predictors of the functional outcome after a hemicraniectomy and attempted to determine the critical age for an unfavorable functional outcome.


METHODS
A total of 38 patients with large hemispheric infarction were treated with a decompressive hemicraniectomy and the corresponding 1-year modified Rankin Scale (mRS) data obtained. An array of clinical variables was then investigated in relation to the functional outcomes.


RESULTS
A multivariate analysis that used binary multiple logistic regression revealed that advanced age was a statistically significant predictor of an unfavorable 1-year functional outcome. In a receiver operating characteristic curve analysis for age, a patient age >58 years was determined as an appropriate cut-off value for predicting an unfavorable outcome. The patients aged >58 years showed an 82% positive predictive value (PPV) for an unfavorable outcome with mRS ≥4, and a 50% PPV for mRS ≥5. Moreover, a patient age cutoff value of >67 years exhibited a 100% PPV for predicting an unfavorable functional outcome with mRS ≥4.


CONCLUSIONS
Advanced age was identified as a significant predictor of an unfavorable outcome and functional dependency. The PPV of a patient age >58 years and >67 years for predicting an unfavorable outcome with functional dependency was 82% and 100%, respectively.
Department of Neurosurgery, Kyungpook National University, Daegu, Republic of Korea; Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu, Republic of Korea. Electronic address: jparkmd@hotmail.com.
Jaechan
J
Park
Department of Neurosurgery, Kyungpook National University, Daegu, Republic of Korea; Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu, Republic of Korea.
Wonsoo
W
Son
Cell and Matrix Research Institute, Kyungpook National University, Daegu, Republic of Korea; Clinical Research Center, Kyungpook National University, Daegu, Republic of Korea.
Joomi
J
Lee
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015984:Causality; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Age; Cerebral infarction; Decompressive surgery; Elderly; Treatment outcome