Assessment of perioperative outcome factors after hemicraniectomy confirms age as the prognostic factor in patients with middle cerebral artery infarction: Evidence from real-world data.

BACKGROUND

Malignant middle cerebral artery (MCA) infarction is a serious condition for which hemicraniectomy can improve survival and outcome. However, it remains unclear to what extent other perioperative factors contribute to the outcome.

METHODS

This monocentric, retrospective observational study included patients with MCA infarction and subsequent hemicraniectomy. Perioperative parameters were collected from 68 patients between 01/2012 and 12/2020. Logistic regression analysis was performed to establish determinants for the outcome measured by the Modified Rankin Scale (mRS) (dichotomized in mRS 0-3: favorable outcome, mRS 4-6: poor outcome) 12 months after stroke.

RESULTS

Before event, most patients had no impairment (mRS 0, 75 %) or mild impairment (mRS 1-3, 23.5 %). 12 months after stroke, 18 patients (32 %) had favorable outcome (mRS 0-3). In univariable analysis, age (OR[95 %CI]: 1.124[1.045,1.208], p = 0.002) and the pre-existing conditions diabetes (OR[95 %CI]: 10.625[1.279,88.293], p = 0.029) and hypertension (OR[95 %CI]: 3.875[1.159,12.961], p = 0.028) were associated with poor outcome, as were more points of effort for intensive care complex treatment in the Simplified Acute Physiology Score (SAPS) in the first two days after stroke (ORday1[95 %CIday1]: 1.109[1.023,1.203], pday1 = 0.012) (ORday2[95 %CIday2]: 1.209[1.078,1.355], pday2 = 0.001). All other collected periinterventional parameters (i.e. sedation, fever) did not influence the outcome. In multivariable analysis, older age (OR[95 %CI]: 1.107[1.029,1.190], p = 0.006) was found to be an independent predictor of higher mRS (4-6). For age, our ROC analysis showed a cut-off point of 57 years.

CONCLUSION

Our data provide information about changes in the degree of impairment and its improvement over time beyond the acute phase of stroke. Of all included parameters, age emerged as the most important prognostic factor.