Department of Neurological Surgery, University of Rochester Medical Center, Rochester, NY, United States.
Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY 14642, United States.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107713. doi: 10.1016/j.jstrokecerebrovasdis.2024.107713. Epub 2024 Apr 5.
Rates of decompressive craniectomy (DC) in acute ischemic stroke (AIS) have been reported to decline over time, attributed to an increase in endovascular therapy (EVT) preventing the development of malignant cerebral edema. We sought to characterize trends in DC in AIS between 2011 and 2020.
We performed a retrospective observational study of U.S. AIS hospitalizations using the National Inpatient Sample, 2011 to 2020. We calculated rates of DC per 10,000 AIS among all AIS hospitalizations, as well as AIS hospitalizations undergoing invasive mechanical ventilation (IMV). A logistic regression to determine predictors of DC was performed.
Of ∼4.4 million AIS hospitalizations, 0.5 % underwent DC; of ∼300,000 AIS with IMV, 5.8 % underwent DC. From 2011 to 2020, the rate of DC increased from 37.4 to 59.1 per 10,000 AIS (p < 0.001). The rate of DC in patients undergoing IMV remained stable at ∼550 per 10,000 (p = 0.088). The most important factors predicting DC were age (OR 4.88, 95 % CI 4.53-5.25), hospital stroke volume (OR 2.61, 95 % CI 2.17-3.14), hospital teaching status (OR 1.54, 95 % CI 1.36-1.75), and transfer status (OR 1.53, 95 % CI 1.41-1.66); EVT status did not predict DC.
The rate of DC in AIS has increased between 2011 and 2020. Our findings are contrary to prior reports of decreasing DC rates over time. Increasing EVT rates do not seem to be preventing the occurrence of DC. Future research should focus on the decision-making process for both clinicians and surrogates regarding DC with consideration of long-term outcomes.
减压性颅骨切除术（DC）在急性缺血性中风（AIS）中的应用比例已被报道随时间推移而下降，这归因于血管内治疗（EVT）的增加可预防恶性脑水肿的发生。我们旨在描述 2011 年至 2020 年期间 AIS 中 DC 的趋势。
我们使用国家住院患者样本进行了一项回顾性观察性研究，纳入了 2011 年至 2020 年的美国 AIS 住院患者。我们计算了所有 AIS 住院患者中每 10000 例 AIS 患者中的 DC 发生率，以及接受有创机械通气（IMV）的 AIS 住院患者。我们还进行了逻辑回归以确定 DC 的预测因素。
在约 440 万例 AIS 住院患者中，0.5%的患者接受了 DC；在约 300000 例接受 IMV 的 AIS 患者中，5.8%的患者接受了 DC。从 2011 年至 2020 年，DC 的发生率从每 10000 例 AIS 的 374 例增加到 591 例（p<0.001）。接受 IMV 的患者中 DC 的发生率保持在每 10000 例约 550 例（p=0.088）。预测 DC 的最重要因素是年龄（OR 4.88，95%CI 4.53-5.25）、医院卒中量（OR 2.61，95%CI 2.17-3.14）、医院教学地位（OR 1.54，95%CI 1.36-1.75）和转移状态（OR 1.53，95%CI 1.41-1.66）；EVT 状态不能预测 DC。
2011 年至 2020 年期间，AIS 中 DC 的应用比例有所增加。我们的发现与先前关于 DC 发生率随时间推移而下降的报告相反。EVT 比例的增加似乎并没有阻止 DC 的发生。未来的研究应集中于临床医生和代理人在考虑长期结果的情况下对 DC 的决策过程。
