Introduction: Decompressive hemicraniectomy has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction. This procedure has been done for malignant MCA infarction at our institution, a tertiary referral centre, since 2011. We aimed to review the outcomes of patients receiving this procedure based on hospital of origin.
Hypothesis: Patients originating outside of a tertiary centre would have worse outcomes and delays in obtaining decompressive hemicraniectomy for malignant MCA infarction.
Methods: We retrospectively reviewed the medical records of all patients who underwent decompressive hemicraniectomy for malignant MCA infarction from March 2011 until March 2014. We compared 30-day mortality as well as time to surgery between patients presenting to the tertiary referral centre and patients presenting to peripheral hospitals. We compared 30-day mortality between those patients receiving surgery within 48 hours and those receiving surgery over 48 hours. We also compared the clinical characteristics of the patients in our cohort to data from published trials.
Results: Eighteen patients underwent decompressive hemicraniectomy during this period of time. The 30-day mortality rate was 10/18 (55.6%). There was no difference in mortality between those presenting to the tertiary referral centre and those presenting to peripheral centres (3/6 [50%] vs 7/12 [58.3%], p=0.99). There was no difference in time to surgery between those presenting to the tertiary referral centre and those presenting to peripheral hospitals (median 44.2 vs 30.5 h, p=0.3933). There was weak evidence of reduced mortality for those undergoing the procedure within 48 hours of onset (6/14 [42.9%] vs 4/4 [100%], p=0.092). The patients in our cohort had no statistically significant difference in mortality compared to those in the hemicraniectomy trials but did have a longer time to surgery and a greater percentage of males.
Conclusions: Mortality rates and time to surgery were comparable regardless of hospital of origin for decompressive hemicraniectomy after malignant MCA infarction.