How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases.

Schär, Ralph T.; Tashi, Shpend; Branca, Mattia; Söll, Nicole; Cipriani, Debora; Schwarz, Christa; Pollo, Claudio; Schucht, Philippe; Ulrich, Christian T.; Beck, Jürgen; Z'Graggen, Werner J.; Raabe, Andreas (2020). How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases. (In Press). Journal of neurosurgery, pp. 1-9. American Association of Neurological Surgeons 10.3171/2020.2.JNS193460

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OBJECTIVE With global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery. METHODS For this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed. RESULTS In total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001). CONCLUSIONS Mortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Schär, Ralph Thomas; Tashi, Shpend; Branca, Mattia; Soell, Nicole; Cipriani, Debora Rosalba; Schwarz, Christa; Pollo, Claudio; Schucht, Philippe; Ulrich, Christian Thomas; Beck, Jürgen; Z'Graggen, Werner Josef and Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

12 May 2020 17:11

Last Modified:

25 Jun 2020 13:15

Publisher DOI:

10.3171/2020.2.JNS193460

PubMed ID:

32330879

Uncontrolled Keywords:

ASA = American Society of Anesthesiologists EBL = estimated blood loss GCS = Glasgow Coma Scale ICU = intensive care unit IMCU = intermediate care unit LOS = length of stay PAC = postacute care PS = Physical Status elderly elective craniotomy mortality oncology postoperative complications

BORIS DOI:

10.7892/boris.143982

URI:

https://boris.unibe.ch/id/eprint/143982

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