• Jaechan Park, Wonsoo Son, and Joomi Lee.
• Department of Neurosurgery, Kyungpook National University, Daegu, Republic of Korea; Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu, Republic of Korea. Electronic address: jparkmd@hotmail.com.
• World Neurosurg. 2016 Sep 1; 93: 104-10.

ObjectiveAlthough age already is known as a crucial factor affecting the functional outcome after a hemicraniectomy for malignant hemispheric infarction, previous studies have used arbitrary age cut-offs of 50, 60, or 70 years. Therefore, this study investigated predictors of the functional outcome after a hemicraniectomy and attempted to determine the critical age for an unfavorable functional outcome.MethodsA total of 38 patients with large hemispheric infarction were treated with a decompressive hemicraniectomy and the corresponding 1-year modified Rankin Scale (mRS) data obtained. An array of clinical variables was then investigated in relation to the functional outcomes.ResultsA multivariate analysis that used binary multiple logistic regression revealed that advanced age was a statistically significant predictor of an unfavorable 1-year functional outcome. In a receiver operating characteristic curve analysis for age, a patient age >58 years was determined as an appropriate cut-off value for predicting an unfavorable outcome. The patients aged >58 years showed an 82% positive predictive value (PPV) for an unfavorable outcome with mRS ≥4, and a 50% PPV for mRS ≥5. Moreover, a patient age cutoff value of >67 years exhibited a 100% PPV for predicting an unfavorable functional outcome with mRS ≥4.ConclusionsAdvanced age was identified as a significant predictor of an unfavorable outcome and functional dependency. The PPV of a patient age >58 years and >67 years for predicting an unfavorable outcome with functional dependency was 82% and 100%, respectively.Copyright © 2016 Elsevier Inc. All rights reserved.

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