Decompressive Craniectomy for Cerebral Complications After Cardiothoracic Surgery and Endovascular Procedures: A Retrospective Study

Abstract

Introduction: The objective of the study is to evaluate clinical outcomes and demographic characteristics of patients undergoing decompressive craniectomy for cerebral complications following cardiothoracic surgery or endovascular procedures. Methods: This single-center retrospective study included 96 patients who underwent decompressive craniectomy between July 2016 and June 2025. Among these, 37 patients who required decompressive craniectomy due to hemorrhage and/or infarction following cardiothoracic surgery or endovascular procedures were included. Demographic characteristics, pre-operative midline shift, post-operative craniectomy size, and modified Rankin Scale scores at discharge were analyzed. Results: The mean age of the 37 patients was 61.2±13.9 years. During follow-up, 81.1% of the patients died. The mean age of survivors was significantly lower than that of non-survivors (p=0.010). No statistically significant association was found between clinical outcome and sex, pre-operative midline shift, or post-operative craniectomy size. Firth penalized logistic regression analysis identified age as the only variable independently associated with mortality (p=0.006). This association remained significant after exclusion of the single pediatric patient in sensitivity analysis (p=0.024). Discussion and Conclusion: Mortality remains high in patients undergoing decompressive craniectomy for cerebral complications following cardiothoracic surgery or endovascular procedures. Age was identified as the only independent predictor of mortality.