Article
Quality of life one year after a neurosurgical intervention in 80 years+ patients
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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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Asita S. Sarrafzadeh
- Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Switzerland; Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Germany
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J. Blatter
- Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Switzerland
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O. Monteventi
- 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
| Published: | May 21, 2013 |
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Outline
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Objective: Increasing life expectancy, along with rising expectations in quality of life (QOL), is producing a significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures. Also types and complexity of procedures changed with more craniotomies and endovascular procedures being performed. Nevertheless, an acute medical illness requiring hospitalization may be followed by a progressive decline, resulting in high mortality rates in this population. To analyse the diagnostics, mortality and quality of life (QOL) one year after a neurosurgical intervention in patients aged 80 years or older (80+).
Method: Retrospective analysis of all neurosurgical patients operated (electively or acutely), age 80+ yrs in 2011 in a major University Hospital. Analysis included: (1) diagnosis and comorbidities (Charlson Comorbidity Index, CCI), (2) status on admission, (3) type of procedures, (4) postsurgical complications, (5) Glasgow Outcome Scale (GOS) at discharge, (6) mortality and QOL at one year post surgery.
Results: 34 patients (mean age 83.4 ± 2,1 yrs) were operated (cranial n = 20; spine n = 14). Tumors (n = 6) were the most frequent cranial pathology, followed by chronic subdural hematomas (n = 5) and miscellaneous (stroke, SAH, trauma, n = 9). For spine, degenerative stenosis (n = 10) and lumbar disc herniation (n = 2) were most frequent, 2 patients had a cervical fracture. Mean CCI on admission was 6 (4–8; lowest comorbidity value = 4/ highest = 17). 15 patients (44%) presented post-surgical complications (11 minor and 4 needing reintervention and/or ICU, 3 of them spine patients). Two patients died until discharge for medical complications. Mean GOS at discharge was 4 (3–5) and mean QOL VAS was 69 ± 17% (100 is optimal, 0 is no QOL). After one year, 6 more patients were dead (1-y-mortality 24%) and 7 patients were severely disabled. QOL (3 patients not available/not willing to respond) was estimated in majority as moderate to low: 9 patients reported severe health quality daily problems, 10 moderate problems and only 4 patients a good QOL.
Conclusions: The present series of elderly patients (80 plus) who underwent surgery reveals the variety of neurosurgical problems to cope and shows the high probability of QOL impairment one year post-surgery, even in presence of a favorable outcome at discharge.
