title: Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction.
abstract: Swollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction.
  
  
  
  All patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size.
  
  
  
  Fourteen out of 45 patients (31%) died during the primary hospitalization (range, 3-44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01-0.77; p = 0.029).
  
  
  
  The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway. jarle.sundseth@rikshospitalet.no.
authors.forename: Jarle
authors.initials: J
authors.lastname: Sundseth
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Antje
authors.initials: A
authors.lastname: Sundseth
authors.affiliation: Department of Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Eva Astrid
authors.initials: EA
authors.lastname: Jacobsen
authors.affiliation: Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: Are Hugo
authors.initials: AH
authors.lastname: Pripp
authors.affiliation: Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sorteberg
authors.affiliation: Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Altmann
authors.affiliation: Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Karl-Fredrik
authors.initials: KF
authors.lastname: Lindegaard
authors.affiliation: Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jon
authors.initials: J
authors.lastname: Berg-Johnsen
authors.affiliation: Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Bente
authors.initials: B
authors.lastname: Thommessen
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality
keywords: Decompressive craniectomy; Middle cerebral artery infarction; Outcome; Predictors; Swollen