Artikel
Subarachnoid hemorrhage (SAH) in advanced age: Comparison of patients aged ‘70–79’ years and ‘80 years and older’
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Autoren
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Nina Brawanski
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Johannes Platz
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Franziska Kunze
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Christian Senft
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Volker Seifert
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Jürgen Konczalla
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: According to actual demographic changes nowadays clinical routine shows an increasing admission rate of elderly patients suffering from aneurysmal subarachnoid hemorrhage (SAH). We retrospectively compared patients aged from ‘70-79’ and patients aged ‘80 years and older’. Aim of the study was to identify differences in outcome and prognostic factors in these two groups.
Method: Patients with SAH were entered into a prospectively collected database. We retrospectively selected the patients aged from ‘70-79’ years (n=138) and patients aged ‘80 years and older’ (80+; n=53) from 1999 to 2014 and compared both groups. Outcome was assessed using the modified Rankin Scale (mRS; favorable (mRS 0-2) and unfavorable (mRS 3-6)) six months after SAH. In the group of patients aged from 70-79 years 30% achieved a favorable outcome vs. 28% of patients in the 80+ group.
Results: In comparison of both groups 80+ suffer less from an early hydrocephalus (p<0.05) and had a lower rate of cerebral vasospasm (p<0.05) and shunt dependence (p<0.05). 51% of the patients were treated by endovascular coiling. On the other hand there had been statistically no difference concerning clinical outcome in these two patient groups. Also the mortality rate was not significantly higher in 80+ (49% vs. 37% 70-79 year group). Additionally there had been no difference between treatment modalities.
Conclusions: There was no difference in clinical outcome comparing both groups. Several pathophysiological and physiological mechanisms in elderly patients (especially 80+) may have a positive influence on typical complications after SAH (like early hydrocephalus, shunt dependence and the occurrence of CVS), like the increasing sclerosis of vessels avoiding CVS and the existing physiological cerebral atrophy in elderly patients avoiding an early hydrocephalus and shunt dependence. In summary this study confirms that a favorable outcome in elderly patients is not uncommon. Furthermore 80+ seem to suffer less from typically complications of SAH. In conclusion patients suffering from SAH aged over 80 years can achieve a favorable outcome.
