Retrospective Consent to Hemicraniectomy after Malignant Stroke among the Elderly, Despite Impaired Functional Outcome

Abstract

Background: Decompressive hemicraniectomy (DHC) after space-occupying strokes among patients older than 60 years has been shown to reduce mortality rates but at the cost of severe disability. There is an ongoing debate about what could be considered an acceptable outcome for these patients. Data about retrospective consent to the procedure after lengthy time periods are lacking. Methods: This study included 79 consecutive patients who underwent DHC during a 7.75-year period. Surviving patients were assessed for functional and psychological outcome, quality of life (QoL) and retrospective consent for the procedure. Patients younger than 60 years were compared with older patients. Results: Of our 79 patients, 44 were younger than 60 years (median 50 years, interquartile range (IQR) 19-59 years) and 35 were older (median 68 years, interquartile range 60-87 years). The 30-day mortality rate was higher for the older group, but the difference was not statistically significant. Functional outcome was significantly better in the younger group: 31% of the patients in this group vs. 10% in the older group had a modified Rankin Scale score of 0-3 (p = 0.046). The mean National Institutes of Health Stroke Scale score was 17 ± 14 for the younger group and 29 ± 15 for the older group (p = 0.002). On the 36-Item Short Form Health Survey, with the exception of the item ‘General health', the older group reported higher values for all items, with statistically significant differences between the 2 groups on the items ‘Role limitation emotional' (p = 0.0007) and ‘Vitality' (p = 0.02). In the younger group, 29% of patients retrospectively declined consent for DHC opposed to 0% of patients in the older group (p = 0.07). Conclusions: Despite impaired functional outcome after DHC, indicators of QoL and retrospective consent are higher for patients older than 60 years over the long term. This finding should be taken into account by those who counsel patients and caregivers with regard to this serious procedure.

A Retrospective Cohort Study to Assess Patient and Physician Reported Outcome Measures After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke

“…Ragoschke-Schumm, et al recorded results from a 4 point life worth living scale (lowest value meaning highest satisfaction). They had a mean of 2.0 for age under 60 and 2.18 for 60 and over [26]. Our results were in between the values from these studies.…”

Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

“…Higher disabilities are not accompanied by worse quality of life, as discussed in recent studies[ 24 , 25 ], future studies should focus more in emotional and psychological aspects of patients and caregivers than simplistic scales like mRS or NIHSS.…”

Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarction: The ‘Real World' Beyond Studies

“…Regarding communication, our data showed that almost all patients with affection of the dominant hemisphere, but also some patients with nondominant hemispheric stroke, displayed a severely limited potential to communicate. Nevertheless, these data should not be put on a level with the patients' judgement of QoL: Weil et al [22] low-up over 7 years and seem to be even higher in the elderly, despite a high grade of disability [23] . In addition to the grade of disability, living conditions and social aspects certainly contribute to QoL.…”