# Early post-operative recovery of consciousness following decompressive craniectomy as a predictor of long-term functional outcome

## TL;DR

Early recovery of consciousness after decompressive craniectomy is strongly linked to better long-term outcomes, especially in younger patients.

## Contribution

This study identifies early recovery of consciousness as a novel predictor of long-term functional outcomes after decompressive craniectomy.

## Key findings

- 53% of patients who regained consciousness within 14 days survived with functional independence, compared to 4% who did not.
- Younger patients (≤50 years) who regained consciousness had a 71% chance of functional independence, versus 27% for older patients (>50 years).

## Abstract

Decompressive craniectomy (DC) can be lifesaving, but many survivors do not regain independence in daily life. Recovery of consciousness in the first post-operative days is regarded as a prognostic factor, however, literature on the relation between early recovery of consciousness and long-term independence is scarce.

To analyse the relation between recovery of consciousness in the first 14 days post-DC and long-term functional outcome.

Glasgow Coma Scale (GCS) motor (M) scores during the first 14 post-DC days of 188 consecutive adult patients undergoing DC for various pathologies were retrospectively extracted from hospital records, together with one-year Glasgow Outcome Scale (GOS) scores. Recovery of consciousness was defined as GCS M6. Outcome was categorised into death (GOS 1), unfavourable survival (GOS 2–3), and favourable survival (GOS 4–5).

Overall, 32 % survived favourably, 21 % unfavourably, and 47 % died. One hundred and eight patients (57 %) regained consciousness during the first two post-operative weeks. At one year, 53 % of M6 patients were functionally independent, versus only 4 % of patients who did not regain consciousness during that time-frame (p < 0.001). Chances of functionally independent survival in M6 patients were significantly higher in patients ≤50 years old than in patients >50 years old (71 % versus 27 %, p < 0.001).

Long-term functional outcome of DC patients differed considerably when assorted for early recovery of consciousness, especially when categorised for age. These results may serve to better inform family members and patients during post-DC counselling.

•Decompressive craniectomy (DC) can be lifesaving, but many do not regain independence.•Recovery of consciousness in the first 14 post-DC days may predict long-term functional outcome.•The relation between early recovery of consciousness and long-term functional outcome was analysed in 188 DC patients.•53 % of patients who regained consciousness survived functionally independent, versus only 4 % of patients who did not.•71 % of conscious patients ≤50 years survived functionally independent, versus only 27 % of patients >50 years old.

Decompressive craniectomy (DC) can be lifesaving, but many do not regain independence.

Recovery of consciousness in the first 14 post-DC days may predict long-term functional outcome.

The relation between early recovery of consciousness and long-term functional outcome was analysed in 188 DC patients.

53 % of patients who regained consciousness survived functionally independent, versus only 4 % of patients who did not.

71 % of conscious patients ≤50 years survived functionally independent, versus only 27 % of patients >50 years old.