Decompressive craniectomy vs. craniotomy only for intracranial hemorrhage evacuation: a propensity matched study

Faisal Jehan, Asad Azim, Peter Rhee, Muhammad Khan, Lynn Gries, Terence OʼKeeffe, Narong Kulvatunyou, Andrew Tang, Bellal Joseph

Research output: Research - peer-reviewArticle

Abstract

BACKGROUND: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established, however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing decompressive craniectomy (DC) vs. craniotomy only (CO) for the evacuation of intracranial hemorrhage. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups: those who underwent craniotomy only (CO) and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow coma scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (SNiF), discharge GCS and GOS score; and complications. RESULTS: We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score (PS) matching, we included 99 of those patients in our study (DC: 33, CO: 66). Matched groups were similar in age (p=0.68), admission GCS score (p=0.50), ISS (p=0.70), h-AIS (p=0.32), and intracranial bleeding characteristics. Overall, 26.3% (n=26) of the patients died and 62.6% (n=62) were discharged to Rehab/SNiF. There was no difference in the mortality rate (27.3% vs. 25.0%; p=0.99), adverse discharge disposition (45% vs. 33%; p=0.66), GCS (p=0.53) and GOS (p=0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION: This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE: Level III, therapeutic.

LanguageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Jul 15 2017

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Decompressive Craniectomy
Intracranial Hemorrhages
Craniotomy
Glasgow Coma Scale
Traumatic Brain Injury
Intracranial Pressure
Mortality
Therapeutics
Traumatic Intracranial Hemorrhage
Propensity Score
Injury Severity Score
Mechanical Ventilators
Anticoagulants
Research Design
Demography
Outcome Assessment (Health Care)
Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Decompressive craniectomy vs. craniotomy only for intracranial hemorrhage evacuation : a propensity matched study. / Jehan, Faisal; Azim, Asad; Rhee, Peter; Khan, Muhammad; Gries, Lynn; OʼKeeffe, Terence; Kulvatunyou, Narong; Tang, Andrew; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, 15.07.2017.

Research output: Research - peer-reviewArticle

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abstract = "BACKGROUND: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established, however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing decompressive craniectomy (DC) vs. craniotomy only (CO) for the evacuation of intracranial hemorrhage. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups: those who underwent craniotomy only (CO) and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow coma scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (SNiF), discharge GCS and GOS score; and complications. RESULTS: We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score (PS) matching, we included 99 of those patients in our study (DC: 33, CO: 66). Matched groups were similar in age (p=0.68), admission GCS score (p=0.50), ISS (p=0.70), h-AIS (p=0.32), and intracranial bleeding characteristics. Overall, 26.3% (n=26) of the patients died and 62.6% (n=62) were discharged to Rehab/SNiF. There was no difference in the mortality rate (27.3% vs. 25.0%; p=0.99), adverse discharge disposition (45% vs. 33%; p=0.66), GCS (p=0.53) and GOS (p=0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION: This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE: Level III, therapeutic.",
author = "Faisal Jehan and Asad Azim and Peter Rhee and Muhammad Khan and Lynn Gries and Terence OʼKeeffe and Narong Kulvatunyou and Andrew Tang and Bellal Joseph",
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T1 - Decompressive craniectomy vs. craniotomy only for intracranial hemorrhage evacuation

T2 - Journal of Trauma and Acute Care Surgery

AU - Jehan,Faisal

AU - Azim,Asad

AU - Rhee,Peter

AU - Khan,Muhammad

AU - Gries,Lynn

AU - OʼKeeffe,Terence

AU - Kulvatunyou,Narong

AU - Tang,Andrew

AU - Joseph,Bellal

PY - 2017/7/15

Y1 - 2017/7/15

N2 - BACKGROUND: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established, however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing decompressive craniectomy (DC) vs. craniotomy only (CO) for the evacuation of intracranial hemorrhage. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups: those who underwent craniotomy only (CO) and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow coma scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (SNiF), discharge GCS and GOS score; and complications. RESULTS: We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score (PS) matching, we included 99 of those patients in our study (DC: 33, CO: 66). Matched groups were similar in age (p=0.68), admission GCS score (p=0.50), ISS (p=0.70), h-AIS (p=0.32), and intracranial bleeding characteristics. Overall, 26.3% (n=26) of the patients died and 62.6% (n=62) were discharged to Rehab/SNiF. There was no difference in the mortality rate (27.3% vs. 25.0%; p=0.99), adverse discharge disposition (45% vs. 33%; p=0.66), GCS (p=0.53) and GOS (p=0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION: This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE: Level III, therapeutic.

AB - BACKGROUND: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established, however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing decompressive craniectomy (DC) vs. craniotomy only (CO) for the evacuation of intracranial hemorrhage. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups: those who underwent craniotomy only (CO) and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow coma scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (SNiF), discharge GCS and GOS score; and complications. RESULTS: We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score (PS) matching, we included 99 of those patients in our study (DC: 33, CO: 66). Matched groups were similar in age (p=0.68), admission GCS score (p=0.50), ISS (p=0.70), h-AIS (p=0.32), and intracranial bleeding characteristics. Overall, 26.3% (n=26) of the patients died and 62.6% (n=62) were discharged to Rehab/SNiF. There was no difference in the mortality rate (27.3% vs. 25.0%; p=0.99), adverse discharge disposition (45% vs. 33%; p=0.66), GCS (p=0.53) and GOS (p=0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION: This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE: Level III, therapeutic.

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