Supplementary Material for: Retrospective Consent to Hemicraniectomy after Malignant Stroke among the Elderly, Despite Impaired Functional Outcome

<b><i>Background:</i></b> Decompressive hemicraniectomy (DHC) after space-occupying strokes among patients older than 60 years has been shown to reduce mortality rates but at the cost of severe disability. There is an ongoing debate about what could be considered an acceptable outcome for these patients. Data about retrospective consent to the procedure after lengthy time periods are lacking. <b><i>Methods:</i></b> This study included 79 consecutive patients who underwent DHC during a 7.75-year period. Surviving patients were assessed for functional and psychological outcome, quality of life (QoL) and retrospective consent for the procedure. Patients younger than 60 years were compared with older patients. <b><i>Results:</i></b> Of our 79 patients, 44 were younger than 60 years (median 50 years, interquartile range (IQR) 19-59 years) and 35 were older (median 68 years, interquartile range 60-87 years). The 30-day mortality rate was higher for the older group, but the difference was not statistically significant. Functional outcome was significantly better in the younger group: 31% of the patients in this group vs. 10% in the older group had a modified Rankin Scale score of 0-3 (p = 0.046). The mean National Institutes of Health Stroke Scale score was 17 ± 14 for the younger group and 29 ± 15 for the older group (p = 0.002). On the 36-Item Short Form Health Survey, with the exception of the item ‘General health', the older group reported higher values for all items, with statistically significant differences between the 2 groups on the items ‘Role limitation emotional' (p = 0.0007) and ‘Vitality' (p = 0.02). In the younger group, 29% of patients retrospectively declined consent for DHC opposed to 0% of patients in the older group (p = 0.07). <b><i>Conclusions:</i></b> Despite impaired functional outcome after DHC, indicators of QoL and retrospective consent are higher for patients older than 60 years over the long term. This finding should be taken into account by those who counsel patients and caregivers with regard to this serious procedure.

**背景：** 针对60岁以上占位性脑卒中患者实施去骨瓣减压术（Decompressive hemicraniectomy, DHC）已被证实可降低患者死亡率，但会以出现严重残疾为代价。目前针对此类患者的可接受预后标准仍存在广泛争议，且尚缺乏关于患者在术后较长时间后对该手术作出追认同意的相关数据。
**方法：** 本研究纳入了7.75年研究周期内连续接受去骨瓣减压术的79例患者，对存活患者的功能、心理预后，生活质量（Quality of Life, QoL）以及该手术的追认同意情况进行了评估，并将60岁以下患者与60岁以上患者分为两组进行对比分析。
**结果：** 本研究的79例患者中，44例为60岁以下患者（中位年龄50岁，四分位间距（interquartile range, IQR）19~59岁），35例为60岁以上患者（中位年龄68岁，四分位间距60~87岁）。60岁以上组的30天死亡率更高，但组间差异未达到统计学显著性。年轻组的功能预后显著更优：该组中31%的患者改良Rankin量表（modified Rankin Scale, mRS）评分处于0~3分区间，而老年组该比例仅为10%（p=0.046）。年轻组的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）平均评分为17±14，老年组为29±15（p=0.002）。在36项简明健康调查量表（36-Item Short Form Health Survey, SF-36）的维度评分中，除‘总体健康’维度外，老年组其余所有维度的评分均更高；两组在‘情感受限角色’（p=0.0007）与‘活力’（p=0.02）维度上的差异具有统计学显著性。年轻组中有29%的患者在术后追认时拒绝同意接受去骨瓣减压术，而老年组该比例为0%（p=0.07）。
**结论：** 尽管去骨瓣减压术后患者的功能预后存在受损情况，但从长期随访来看，60岁以上患者的生活质量指标与术后追认同意率均更高。临床医师在向此类患者及其照护者告知该重大手术的相关信息时，应将本研究结果纳入考量范畴。