Buffagni Daniel, Zamarron Alvaro, Melgosa Isabel, Gutierrez-Gonzalez Raquel
Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
Department of Neurosurgery, Puerta de Hierro University Hospital, IDIPHISA, Madrid, Spain.
Front Neurol. 2023 Jul 26;14:1222080. doi: 10.3389/fneur.2023.1222080. eCollection 2023.
This study aims to assess the quality of life (QoL) in patients who have undergone decompressive craniectomy (DC) for any pathology that has caused life-threatening intracranial hypertension. Similarly, it aims to evaluate QoL perceived by caregivers or external informants. In addition to that, the last purpose is to determine which clinical or therapeutic factors could correlate with a better QoL.
A single-center cross-sectional study was designed. All patients over 18 years old who underwent a supratentorial DC at our department due to intracranial hypertension of any etiology, from January 2015 to December 2021, were retrospectively selected. Patients with incomplete follow-up (under 1 year from the event or those who died) or who declined to participate in the study were excluded. QoL was assessed with SF-36 and CAVIDACE scales. The correlation between clinical and therapeutic variables and SF-36 subscales was studied with Spearman's correlation and the Mann-Whitney U-test.
A total of 55 consecutive patients were recruited: 22 patients had died, three were missed for follow-up, and 15 declined to participate, thus 15 subjects were finally included. The mean follow-up was 47 months (IQR 21.5-67.5). A significant reduction in the "role physical" and "role emotional" subscales of SF-36 was observed compared with the general population. According to caregivers, a significant reduction was assigned to the "physical wellbeing" and "rights" domains. The "physical functioning" score was poorer in women, older patients, those with dominant hemisphere disease, those who required tracheostomy, and those with poor outcomes in the modified Rankin scale. A strong correlation was found between the QoL index at the CAVIDACE scale and the SF-36 subscales "physical functioning" and "role physical".
Most patients and caregivers reported acceptable QoL after DC due to a life-threatening disease. A significant reduction in SF- 36 subscales scores "role limitation due to physical problems" and "role limitation due to emotional problems" was referred by patients. According to caregivers' QoL perception, only 25% of the survey's participants showed low scores in the QoL index of the CAVIDACE scale. Only 26.7% of the patients showed mood disorders.
本研究旨在评估因任何导致危及生命的颅内高压的病理情况而接受减压颅骨切除术（DC）的患者的生活质量（QoL）。同样，它旨在评估照顾者或外部信息提供者所感知的生活质量。除此之外，最后一个目的是确定哪些临床或治疗因素可能与更好的生活质量相关。
设计了一项单中心横断面研究。回顾性选取了2015年1月至2021年12月期间因任何病因导致颅内高压在我科接受幕上减压颅骨切除术的所有18岁以上患者。排除随访不完整（事件发生后不足1年或死亡者）或拒绝参与研究的患者。使用SF-36和CAVIDACE量表评估生活质量。采用Spearman相关性分析和Mann-Whitney U检验研究临床和治疗变量与SF-36子量表之间的相关性。
共招募了55例连续患者：22例患者死亡，3例失访，15例拒绝参与，最终纳入15例受试者。平均随访时间为47个月（四分位间距21.5 - 67.5）。与一般人群相比，观察到SF-36的“身体角色”和“情感角色”子量表有显著降低。根据照顾者的评估，“身体健康”和“权利”领域有显著降低。在女性、老年患者、优势半球疾病患者、需要气管切开术的患者以及改良Rankin量表预后较差的患者中，“身体功能”得分较低。在CAVIDACE量表的生活质量指数与SF-36子量表“身体功能”和“身体角色”之间发现了强相关性。
大多数患者和照顾者报告称，因危及生命的疾病接受减压颅骨切除术后生活质量尚可接受。患者报告称SF-36子量表“因身体问题导致的角色限制”和“因情感问题导致的角色限制”得分显著降低。根据照顾者对生活质量的感知，只有25%的调查参与者在CAVIDACE量表的生活质量指数中得分较低。只有26.7%的患者表现出情绪障碍。
