Abstract 2801: Improved Outcomes among Patients with Decompressive Hemicraniectomy over the Last Decade: Insights from the Nationwide Inpatient Sample
Background: Hemicraniectomy provides a substantial survival benefit for patients with malignant middle cerebral artery infarcts. Over the last few years, our understanding of patient selection criteria for this potentially life-saving procedure has increased. Little is known about whether hemicraniectomy performance has improved outcomes following the procedure outside of clinical trials. Our objective was to evaluate trends in survival and discharge outcomes of ischemic stroke patients receiving hemicraniectomy in the United States over the last decade.
Methods: Data from the Nationwide Inpatient Sample for the years 2001 through 2009 were reviewed. Hospitalizations with a discharge diagnosis of an acute ischemic stroke (ICD-9 codes: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 424.01, 434.11, 434.91 and 436) were included. Hemicraniectomy utilization was determined using procedure codes 01.2, 01.25 and 02.01. Nationwide estimates of deaths and discharge destination were calculated for each year within the hemicraniectomy subset. The Cochrane Armitage test was used to assess trend across the years.
Results: The study included information from 4,917,217 stroke discharges over 9 years. Of these, an estimated 3,447 (0.07%) patients received a hemicraniectomy. There was a progressive decrease in mortality among hemi-craniectomy patients, from 50.1% in 2001 to 26.2% in 2009; trend p=0.016. This survival benefit over the years was primarily seen amongst males (trend p=0.04) and in the younger age group (age <45 years trend p=0.06). Discharges to home (independent or with home care) showed a small decrease in trend over the 9 years. However discharges to rehabilitation facilities and nursing homes have increased over the years (Figure).
Conclusions: Over the last decade, deaths from hemicraniectomy have decreased. A considerable proportion of survivors are being discharged to rehabilitation facilities and nursing homes. Appropriate patient selection and timing for hemicraniectomy has improved survival outcomes for these patients over the last decade. Data on long term neurologic recovery and patient satisfaction are needed.
- © 2012 by American Heart Association, Inc.