Cost-effectiveness of decompressive craniectomy in non-traumatic neurological emergencies

Malmivaara, Kirsi; Öhman, Juha; Kivisaari, Riku; Hernesniemi, Juha; Siironen, Jari

doi:10.1111/j.1468-1331.2010.03162.x

Cited by 16 publications

(15 citation statements)

References 21 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In adult patients [3, 12, 14, 21, 52, 53, 62–70], the rate of superficial complications was 8.1 % (81/1003), while in pediatric patients [71, 72], it was 6.5 % (4/62). The rate of superficial complications in the neonatal population was 43 % (3/7) [73], but this may have been biased by the very small sample size.…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of meningitis or ventriculitis was 6.1 % (63/1035) in adult patients [3, 11, 12, 14, 21, 39, 42, 56, 62, 70, 80, 81, 83–89] and 8.1 % (3/37) in pediatric patients [77, 82]. …”

Section: Resultsmentioning

confidence: 99%

“…Cranioplasty carries its own risks and as with complications associated with DC, some of these complications may require additional surgery, which further increases the risk to the patient for neurological deterioration or death. Length of hospital stay and costs of the procedures are also an important consideration [10–12]. Thus, an understanding of the risks of both procedures is necessary for neurologists and neurosurgeons advising patients and their families.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

View full text Add to dashboard Cite

Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

View full text Add to dashboard Cite

show abstract

“…We assume that this was caused by the relatively small number of patients (n = 131) that were included in this study, in comparison to the larger numbers that have been included in other stroke reports 2)3-5)11)12)14)17)25)26)…”

Section: Discussionmentioning

confidence: 99%

“…Preexisting disabilities and severe comorbid conditions are also important factors that increase poor outcomes, and both are more prominent in elderly patients 13)17)21)22)…”

Section: Discussionmentioning

confidence: 99%

Outcome Following Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction in Patients Older Than 70 Years Old

Choi

Kim

et al. 2012

J Cerebrovasc Endovasc Neurosurg

View full text Add to dashboard Cite

ObjectiveMalignant middle cerebral artery (MCA) infarction occurs in 10% of all ischemic strokes and these severe strokes are associated with high mortality rates. Recent clinical trials demonstrated that early decompressive craniectomy reduce mortality rates and improves functional outcomes in healthy young patients (less than 61 years of age) with a malignant infarction. The purpose of this study was to assess the efficacy of decompressive craniectomy in elderly patients (older than 70 years of age) with a malignant MCA infarction.MethodsBetween February 2008 and October 2011, 131 patients were diagnosed with malignant MCA infarctions. We divided these patients into two groups: patients who underwent decompressive craniectomy (n = 58) and those who underwent conservative care (n = 73). A cut-off point of 70 years of age was set, and the study population was segregated into those who fell above or below this point. Mortality rates and functional outcome scores were assessed, and a modified Rankin Scale (mRS) score of > 3 was considered to represent a poor outcome.ResultsMortality rates were significantly lower at 29.3% (one-month mortality rate) and 48.3% (six-month mortality rate) in the craniectomy group as compared to 58.9% and 71.2%, respectively, in the conservative care group (p < 0.001, p = 0.007). Age (≥70 years vs. < 70 years) did not statistically differ between groups for the six-month mortality rate (p = 0.137). However, the pre-operative National Institutes of Health Stroke Scale (NIHSS) score did contribute to the six-month mortality rate (p = 0.047).ConclusionDecompressive craniectomy is effective for patients with a malignant MCA infarction regardless of their age. Therefore, factors other than age should be considered and the treatment should be individualized in elderly patients with malignant infarctions.

show abstract

Cost‐Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia

Moran

Shrime²,

Nang

et al. 2017

World j. surg.

View full text Add to dashboard Cite

show abstract

Cost-effectiveness of decompressive craniectomy in non-traumatic neurological emergencies

Abstract: Mortality after non-traumatic neurological emergencies leading to decompressive craniectomy was high, and the HRQoL index of the survivors was poor. Most survivors were, however, able to live at home, and the cost of neurosurgical treatment for a QALY gained was acceptable.

Cited by 16 publications

References 21 publications

Complications Associated with Decompressive Craniectomy: A Systematic Review

Complications Associated with Decompressive Craniectomy: A Systematic Review

Outcome Following Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction in Patients Older Than 70 Years Old

Cost‐Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia

Contact Info

Product

Resources

About