title: Patient Age and the Outcomes after Decompressive Hemicraniectomy for Stroke: A Nationwide Inpatient Sample Analysis.
abstract: Decompressive hemicraniectomy (DHC) for space-occupying cerebral infarction in older adults remains controversial, and there are limited nationwide data evaluating the outcomes after craniectomy for stroke by patient age.
  
  
  
  Patients who underwent DHC for ischemic stroke were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable logistic regression examined in-hospital mortality and a poor outcome (death, tracheostomy and gastrostomy, or discharge to institutional care). Covariates included year of admission, comorbidities, severity indices, and treatment variables (including the timing of decompression).
  
  
  
  Craniectomy was performed in 1673 patients: 62.4 % were aged 18-60 years, 20.6 % aged 61-70 years, and 17.0 % aged greater than 70 years. DHC was associated with reduced adjusted odds of in-hospital death compared with medical treatment alone among patients with cerebral edema in all age categories, including those older than 70 years (p ≤ 0.008). However, among surgical patients, the adjusted odds of mortality were significantly greater for patients aged 61-70 (30.7 %, p = 0.02) and greater than 70 years (34.5 %, p = 0.02), but not different for patients aged 51-60 (22.8 %), compared to those aged 18-50 years (19.7 %). The adjusted odds of a poor outcome also increased significantly with age, particularly for patients greater than 60 years.
  
  
  
  In this nationwide analysis, DHC was associated with reduced mortality regardless of patient age, including among those aged greater than 70 years. However, patients aged greater than 60 years treated surgically experienced higher odds of mortality (32.4 %), discharge to institutional care (47.1 %), and a poor outcome (77.0 %) compared with younger patients.
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Hormuzdiyar H
authors.initials: HH
authors.lastname: Dasenbrock
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Faith C
authors.initials: FC
authors.lastname: Robertson
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: M Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Donovan
authors.initials: D
authors.lastname: Guittieres
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org.|Department of Neurosurgery, Brigham and Women's Hospital,Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org.|Harvard Medical School, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. wgormley@partners.org.
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000453:epidemiology / Q000601:surgery; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Age; Cerebral infarction; Decompressive hemicraniectomy; Hemicraniectomy; Ischemic stroke; Middle cerebral artery; Nationwide inpatient sample