Artikel
How safe are elective craniotomies for elderly patients in the modern era of neurosurgery? A prospective cohort study of 1452 consecutive cases
Wie sicher sind elektive Kraniotomien bei älteren Patienten in der modernen Neurochirurgie? Eine prospektive Kohortenstudie über 1452 konsekutive Fälle
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Autoren
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Ralph Schär
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Christa Schwarz
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Shpend Tashi
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Mattia Branca
- Universität Bern, Clinical Trials Unit Bern, Bern, Switzerland
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Nicole Söll
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Debora Cipriani
- Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
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Claudio Pollo
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Philippe Schucht
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Christian Ulrich
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Jürgen Beck
- Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
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Werner Z\'Graggen
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
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Andreas Raabe
- Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: To assess the safety of elective craniotomy for elderly patients in modern neurosurgery.
Methods: This is a prospective cohort, single-centre study at a tertiary hospital over seven years. Adult patients who underwent elective craniotomy were allocated to three age groups (group 1 <65 years [n=1008], group 2 ≥65 to <75 [n=315], group 3 ≥75 [n=129]) . The primary outcome was 30-day mortality after craniotomy. The 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, length of hospital stay, and rate of discharge to home directly. Descriptive analysis was performed for baseline characteristics, surgical, postoperative care and patient transfer data. Binary outcomes measures were analysed by Fisher exact test or Chi-squared test, while the Kruskal-Wallis test was used to account for large values for continuous outcomes. Adjustment for ASA class, estimated blood loss and duration of surgery was also tested as a comparison using multiple logistic regression to account for potential selection bias. For significant differences a post-hoc analysis was performed.
Results: This study included 1452 patients (mean age 55.4 ± 14.7 years). Overall mortality was 0.55% (n=8) and there were no significant differences between the three groups. Patients with fatal outcome had a significantly higher ASA class (2.88 ± 0.35 vs. 2.42 ± 0.62, 95%CI 0.46 [0.03, 0.89], P = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs. 436 ± 545 ml; difference of 1008 with 95%CI [618, 1398], P = <0.001). Significant differences were found in rate of emergency postoperative head CTs (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; P = 0.006), length of hospital stay (group 1: 6.35 ± 3.82 days, group 2: 6.59 ± 4.12, group 3: 7.21 ± 3.61; P = 0.019), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], group 3: 44.2% [n = 57]; P < 0.001). Remaining secondary outcomes were similar between the three groups.
Conclusion: Mortality after elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, also for elderly patients. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.
