gms | German Medical Science

Objective: The semi-sitting position is used by many neurosurgeons dealing with pathologies in the posterior cranial fossa. However, hypotension and venous air embolism (VAE) are potential issues in this position. Older patients often have limited cardiovascular and respiratory compensatory capacities compared to younger patients. Here we investigated, if elderly patients are exposed to more risk for complications when operated in semi-sitting position.

Methods: Clinical data were analysed retrospectively in a consecutive series of 755 patients who were operated between 1996 and 2016 in the semi-sitting position. From the 755 patients there were 66 patients who are older than 70 years. The incidence of VAE, severe hypotension (drop of blood pressure by more than 20 mmHg) and the postoperative course were compared between patients older than 70 years and patients who were younger.

Results: There were no significant differences for the incidence of the air embolism between the two groups (12% vs. 18% P =0.15). There were also no differences for the occurrence of a marked decrease of PtCo2 (5% vs. 4% P=0.73) or severe hypotension (4,6% vs. 3% respectively, P=0.57). The surgical time in minutes (240 ± 116 vs. 254 ± 120 P=0.34) as well as hospital stay in days were comparable (16 ± 10 vs. 18, 8 ± 11 P=0.07). However, the time spent in the intensive care unit in days after surgery was significantly longer in patients older than 70 years (2 ± 6 vs. 6 ± 10 P=0.01).

Conclusion: There was no increase in complication rates in elderly patients operated in the semi-sitting position. Our results suggest that age per se should not be considered a factor excluding patients from being operated in the semi-setting position.