Article
Operate or not the very elderly neurosurgical patients: a single center 1-year survey
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Authors
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Renato Gondar
- Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Switzerland
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Karl Schaller
- Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Switzerland
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Asita S. Sarrafzadeh
- Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Switzerland; Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Germany
| Published: | May 13, 2014 |
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Outline
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Objective: In parallel to the increasing life expectancy, along with rising expectations in quality of life and medical treatment, a higher proportion of very elderly patients (aged 80 years or older, 80+) present for neurosurgical elective and/or emergency consultations. We aimed to evaluate the most relevant diagnostics of 80+ patients and to find criteria, which may benefit from a neurosurgical intervention.
Method: All consecutive patients (80+ yrs) consulted by a neurosurgeon in a major university hospital over a 1-year period (5/2012-4/2013) were prospectively included. Data analysis included: (1) diagnosis/comorbidities (Charlson Comorbidity Index, CCI), (2) neurostatus at admission, (3) percentage of surgically treated patients, (4) type of procedures/complications, (5) Glasgow Outcome Scale (GOS) at discharge. Data are given as mean values ± SD with interquartile range (IQR) if not specified. For treatment, the opinion of the patient, family and surgeon was documented.
Results: 148 patients with a mean age of 84.9 (± 4. 2yrs, range 80-97) were included. The most frequent diagnosis was trauma (26% cerebral, 13% spinal), followed by chronic subdural hematoma (cSDH, 10%), lumbar degenerative stenosis (10%), while stroke (8%) and tumors (5% cerebral, 2% spinal) were rare. Admission GCS was 14 (14-15 IQR) and the CCI 6 (5-8 IQR, lowest/highest comorbidities charge: 4/17). 60 (41%) patients underwent a neurosurgical intervention (mostly cranial). The most frequently performed surgical procedure was the evacuation of a cSDH (32%), followed by lumbar decompression (20%). Though brain trauma was the main diagnosis, surgery was performed only in a few patients (10%). Tumor surgery was also rarely performed. In 63 cases (43%), treatment decision was taken by the physician only – due to an emergency situation. Mean GOS at the discharge was 4 (3-5) (equal in the surgical subpopulation). Mortality rate was 17% with a comparable CCI in survivors vs non-survivors.
Conclusions: The main diagnosis among the elderly was trauma, whereas cSDH was the most frequently operated pathology. Interestingly, comorbidity was not associated with mortality, encouraging surgery in very elderly patients. Nevertheless, consideration of comorbidities remains relevant for the treatment decision.
