Assessment of Outcomes After Decompressive Craniectomy—An Institutional-Based Study from India

Abstract

Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignant strokes. We aimed to identify the risk factors and assess the long-term functional outcome in patients with malignant stroke undergoing DC. Methods: We conducted an ambispective study on patients (>18 years) undergoing DC between January 2016 and January 2019. Demographic data, stroke risk factors, clinical characteristics, and serial imaging findings were collected. We measured the functional outcomes using the National Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Ranking Scale (mRS), and Barthel index (BI) at 3, 6, and 12 months postoperatively. We did univariate and multivariate regression analyses for the independent variables and outcomes. Results: On admission, the 93 patients (70 males) had a mean GCS of 11.77 (standard deviation [SD]: 2.90) and a mean NIHSS score of 13.65 (SD: 4.41). Diabetes (odds ratio [OR]: 1.76; 0.67-4.46, 95% confidence interval [CI]) and ischemic heart disease (OR: 4.50; 1.44-14.07, 95% CI) showed a positive correlation with the outcome. Forty patients underwent surgery within 48 h of stroke onset, while 53 patients were operated on after 48 h. Twenty-two (23.66%) patients died during the study period, and 55 patients (59.14%) had an mRS score <2 one year after the stroke. Conclusions: DC can produce favorable outcomes in patients with malignant strokes, and early aggressive intervention helps improve the prognosis and quality of life. Only a few studies were reported on the results of DC in stroke, much less from developing countries like India.