Early post-operative recovery of consciousness following decompressive craniectomy as a predictor of long-term functional outcome

Introduction

Decompressive craniectomy (DC) can be lifesaving, but many survivors do not regain independence in daily life. Recovery of consciousness in the first post-operative days is regarded as a prognostic factor, however, literature on the relation between early recovery of consciousness and long-term independence is scarce.

Research question

To analyse the relation between recovery of consciousness in the first 14 days post-DC and long-term functional outcome.

Material and methods

Glasgow Coma Scale (GCS) motor (M) scores during the first 14 post-DC days of 188 consecutive adult patients undergoing DC for various pathologies were retrospectively extracted from hospital records, together with one-year Glasgow Outcome Scale (GOS) scores. Recovery of consciousness was defined as GCS M6. Outcome was categorised into death (GOS 1), unfavourable survival (GOS 2–3), and favourable survival (GOS 4–5).

Results

Overall, 32 % survived favourably, 21 % unfavourably, and 47 % died. One hundred and eight patients (57 %) regained consciousness during the first two post-operative weeks. At one year, 53 % of M6 patients were functionally independent, versus only 4 % of patients who did not regain consciousness during that time-frame (p < 0.001). Chances of functionally independent survival in M6 patients were significantly higher in patients ≤50 years old than in patients >50 years old (71 % versus 27 %, p < 0.001).

Discussion and conclusion

Long-term functional outcome of DC patients differed considerably when assorted for early recovery of consciousness, especially when categorised for age. These results may serve to better inform family members and patients during post-DC counselling.