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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Decompressive Hemicraniectomy for Acute Ischemic Stroke in the US: Characteristics and Outcomes
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Decompressive Hemicraniectomy for Acute Ischemic Stroke in the US: Characteristics and Outcomes

机译：对美国急性缺血性卒中的解压缩术术：特征和结果

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Objectives: Decompressive hemicraniectomy can be life-saving for malignant middle cerebral artery acute ischemic stroke (AIS). However, utilization and outcomes for hemicraniectomy in the US are not known. We sought to analyze baseline characteristics and outcomes of patients receiving hemicraniectomy for AIS in the US. Materials and Methods: We identified adults who received hemicraniectomy for AIS, identified with validated International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) code in the Nationwide Readmissions Database 2014. We calculated 30-day readmission rates, reasons for readmission, and procedures performed. Results: 2850 of 531,896 AIS patients (0.54%) received hemicraniectomy. Although patients receiving hemicraniectomy were more likely to be younger (57.0, 95% CI 56.0-58.0; vs 70.9, 95% CI 70.6-71.2; p < 0.0001) and male (40% vs 51.2% female; p<0.0001), 46.3% of patients who received hemicraniectomy were age 60 years and older. Patients 60 years or older receiving hemicraniectomy were more likely to die (29.9% vs 21.9%, p = 0.0081). Hemicraniectomy was more frequently performed at large hospitals (75.3% vs 57.7%; p < 0.0001) in urban areas (99.1% vs 90.3%; p < 0.0001) designated as metropolitan teaching hospitals (88.3% vs 63.4%; p < 0.0001). 30-day readmissions were most commonly due to infection (31.5%), non-infectious medical complications (17.7%), and surgical complications (13.8%). These readmissions were critical. Conclusions: Although hemicraniectomy is used more frequently in the treatment of younger, male, ischemic stroke patients, only half of the patients receiving hemicraniectomy in 2014 were <60 years old. Regardless of age, hemicraniectomy is a geographically segregated procedure, only being performed in large metropolitan teaching hospitals.
机译：目的：去骨瓣减压术可以挽救恶性大脑中动脉急性缺血性卒中（AIS）的生命。然而，在美国，半颅骨切除术的利用率和结果尚不清楚。我们试图分析美国接受半开颅手术治疗AIS患者的基线特征和结果。材料和方法：我们确定了因AIS接受半颅骨切除术的成年人，并在2014年全国再入院数据库中使用经验证的国际疾病分类、第九次修订、临床修改（ICD-9）代码进行了识别。我们计算了30天的再入院率、再入院原因和执行的程序。结果：531896例AIS患者中有2850例（0.54%）接受了半颅骨切除术。尽管接受半颅骨切除术的患者更可能年轻（57.0,95%可信区间56.0-58.0；vs 70.9,95%可信区间70.6-71.2；p<0.0001）和男性（40%vs 51.2%女性；p<0.0001），但接受半颅骨切除术的患者中46.3%的年龄在60岁及以上。60岁或以上接受半颅骨切除术的患者更有可能死亡（29.9%比21.9%，p=0.0081）。在城市地区（99.1%对90.3%；p<0.0001）被指定为大都会教学医院（88.3%对63.4%；p<0.0001）的大型医院（75.3%对57.7%；p<0.0001）进行半颅骨切除术的频率更高。30天再入院最常见的原因是感染（31.5%）、非感染性医疗并发症（17.7%）和手术并发症（13.8%）。这些再入院至关重要。结论：尽管在年轻男性缺血性中风患者的治疗中，半骨瓣开颅术的使用频率更高，但2014年接受半骨瓣开颅术的患者中只有一半年龄<60岁。无论年龄大小，半开颅手术都是一种地理隔离的手术，只在大都市的大型教学医院进行。

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