Co-morbidity as a Predictor of Outcome in Patients with Idiopathic Normal-Pressure Hydrocephalus
A critical question in the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (iNPH) is which preoperative factors can most reliably predict outcomes following shunt insertion. The number and type of co-morbidities are increasingly being
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Abstract Introduction A critical question in the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (iNPH) is which preoperative factors can most reliably predict outcomes following shunt insertion. The number and type of co-morbidities are increasingly being viewed as important predictive indicators. Materials and Methods Between 1997 and 2005, 100 patients were implanted with a gravitational ventriculoperitoneal shunt as a treatment for iNPH. All coincident disease processes were recorded. Eighty-two of these patients underwent follow-up of 2 years post-operation. The results of this prospective follow-up examination (Kiefer Score, NPH Recovery Rate) were compared with the preoperative Co-morbidity Index (CMI). Results Of the patients with a CMI score of 0–1 (n = 18), 67% experienced an excellent outcome, 28% a good outcome, and 5% and 0% fair and poor outcomes, respectively. A CMI score of 2–3 was associated with markedly poorer outcomes (n = 33); 42% excellent, 30% good, 18% fair and 10% poor. A score of 4–5 was related to 14% excellent, 27% good, 23% fair and 36% poor outcomes (n = 22). Remarkably, a few patients scoring between 6 and 8 on the CMI scale experienced a favorable outcome. The outcomes for this latter group were 0% excellent, 10% good, 45% fair and 45% poor (n = 9). Conclusion Co-morbidity is a statistically significant predictor of the quality of clinical outcome for patients with iNPH undergoing shunt therapy. Keywords Co-morbidity • outcome • idiopathic normalpressure hydrocephalus (iNPH)
U. Meier () and J. Lemcke Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, Berlin D-12683, Germany e-mail: [email protected]
Introduction Patients with idiopathic normal-pressure hydrocephalus (iNPH) are usually elderly and, as such, often present multiple co-morbidities. In this prospective audit, we aim to evaluate whether a Co-morbidity Index (CMI) (7) can be used to provide a prognostic indicator for the quality of clinical outcomes following shunt surgery for iNPH.
Materials and Methods In the Department of Neurosurgery at the Unfallkrankenhaus Berlin, Germany between September 1997 and July 2005, 100 patients were diagnosed with iNPH and treated surgically. The 65 men and 35 women had an average age of 67 at diagnosis (range 27–83). All patients underwent implantation of gravitational valves (54 x Miethke-Aesculap® Dual switch valve, 20 x programmable Codman® Medos valve with Miethke-Aesculap® gravitational assistant valve, 26 x Miethke-Aesculap® proGAV). It was possible to follow-up 82 of these patients over a 2 year postoperative period. Twelve patients died from causes unrelated to either the shunt operation or their iNPH between 10 and 19 months postoperatively (six from heart disease, three from neoplastic disease, two from pneumonia and one from renal failure). One patient died perioperatively from a pulmonary embolism despite thromboprophylaxis (1% perioperative mortality). Five patients were lost to follow-up.
Diagnosis Patients who displayed g
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