PMID- 19911887
OWN - NLM
STAT- MEDLINE
DCOM- 20101028
LR  - 20181201
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 113
IP  - 4
DP  - 2010 Oct
TI  - Nationwide study of decompressive surgery for malignant supratentorial infarction 
      in the Czech Republic: utilization and outcome predictors. Clinical article.
PG  - 897-900
LID - 10.3171/2009.10.JNS09888 [doi]
AB  - OBJECT: Decompressive surgery within 48 hours in patients younger than 60 years 
      of age reduces mortality and morbidity from malignant supratentorial infarction. 
      The goal of this study was to characterize the utilization of decompressive 
      surgery in the Czech Republic in 2006. METHODS: This nationwide study was 
      undertaken from September to December 2007 using a questionnaire sent to all 
      neurosurgery departments in the Czech Republic. Diagnosis of brain infarction and 
      decompressive surgery was based on discharge codes. Patient data were retrieved 
      from hospital charts. Favorable outcome was defined as a modified Rankin scale 
      score </=4 on the day of discharge from the hospital. RESULTS: Data were obtained 
      from 15 of the 16 neurosurgery departments in the Czech Republic (94%) and from 
      39 patients (11 female [28%]). The average patient age was 52 +/-14 years (11 
      patients > 60), median time to surgery was 48 hours (interquartile range [IQR] 
      26-67 hours; 15 patients > 48 hours), median National Institutes of Health Stroke 
      Scale score was 22 (IQR 16-30), median infarct volume was 341 cm(3) (IQR 243-375 
      cm(3)), mean shift from the midline was 9.9 +/- 4.1 mm, median duration of 
      hospitalization was 19 days (IQR 13-30 days), and mean bone flap surface area was 
      75 cm(2) (IQR 70-97 cm(2)). A favorable outcome was achieved in 19 patients (49%). 
      The median number of procedures per site in 2006 was 1.5 (range 0-13 procedures). 
      Five sites (31%) serving one-third of the entire population did not perform any 
      decompressive surgery. No variable was a significant predictor of outcome in a 
      multiple regression model. CONCLUSIONS: In 2006 decompressive surgery was 
      underutilized and occurred late in the clinical course in the Czech Republic. 
      Revision of national guidelines is necessary to incorporate the latest data and 
      ensure that the patients who can benefit most receive treatment.
FAU - Bar, Michal
AU  - Bar M
AD  - Neurology, Neurosurgery, and Radiology Department, Faculty Hospital, Ostrava, 
      Czech Republic. michal.bar@fno.cz
FAU - Mikulik, Robert
AU  - Mikulik R
FAU - Skoloudik, David
AU  - Skoloudik D
FAU - Czerny, Daniel
AU  - Czerny D
FAU - Lipina, Radim
AU  - Lipina R
FAU - Klecka, Lukas
AU  - Klecka L
FAU - Juran, Vilem
AU  - Juran V
FAU - Mracek, Jan
AU  - Mracek J
FAU - Vondracova, Denisa
AU  - Vondracova D
FAU - Hrabalek, Lumir
AU  - Hrabalek L
FAU - Brzezny, Richard
AU  - Brzezny R
FAU - Dienelt, Jan
AU  - Dienelt J
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Aged
MH  - Cerebral Infarction/epidemiology/etiology/*surgery
MH  - Czech Republic/epidemiology
MH  - Decompression, Surgical/*statistics & numerical data
MH  - Female
MH  - Health Care Surveys
MH  - Humans
MH  - Infarction, Middle Cerebral Artery/epidemiology/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Supratentorial Neoplasms/complications/epidemiology/*surgery
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2009/11/17 06:00
MHDA- 2010/10/29 06:00
CRDT- 2009/11/17 06:00
PHST- 2009/11/17 06:00 [entrez]
PHST- 2009/11/17 06:00 [pubmed]
PHST- 2010/10/29 06:00 [medline]
AID - 10.3171/2009.10.JNS09888 [doi]
PST - ppublish
SO  - J Neurosurg. 2010 Oct;113(4):897-900. doi: 10.3171/2009.10.JNS09888.