Introduction: A review of the literature of DECIMAL, DESTINY, and HAMLET showed that patients had reduced fatalities and improved outcomes, but excluded those over sixty years old. Zhao et al. recruited patients up to eighty years of age and showed improved outcomes and decreased mortality through all age groups. We take a look at national inpatient sample database to look at the length of stay after decompression and discharge disposition.
Methods: The national inpatient sample (NIS) database was utilized for this study. Pt were selected from 2005 to 2009 using ICD 9 codes for CVA including 43401, 43411, and 43491. A subset of patients were determined using ICD 9 code for craniectomy, “0124”. Data was analyzed in SPSS using a 2-way anova. Pt were broken into groups Elderly which included those sixty-five year old and older and those who had craniectomy within 1 day of admission.
Results: The NIS database had a total of 502262 stroke diagnoses with 478 patients requiring craniectomy. 223 received craniectomy within 1 day of admission. Elderly patients showed decreased length of stay regardless of craniectomy timing 16.8 days versus 25.5 days and this held even when in hospital deaths were removed with p=0.002. However, elderly patients had and increased likely hood of being discharged to nursing home, skilled nursing facility, or long term acute care hospital. Elderly had increased mortality 34% versus 23% with p=0.017.
Conclusions: Elderly patients likely had decreased length of stay due to increased availability of funding. Another confounding to this data due to lack of funding younger patients may just be taken home without the ability to pay for nursing home care. I think this study shows that craniectomy does decrease mortality when required for stroke as compared to previous publications.
Patient Care: decompressive craniectomy for stroke
Learning Objectives: NIS database improved mortality with stroke and decompressive craniectomy.