Introduction: The general and neurosurgical population is aging. With more patients over the age of 65 undergoing elective craniotomies, it is essential to identify risk factors within this demographic to safely choose surgical candidates in hopes of limiting perioperative complications.
Methods: A retrospective review was conducted to identify all patients > 65 years of age who underwent an elective craniotomy at a single academic medical center from 2007-2015 to identify risk factors for 30-day morbidity/mortality. Potential risk factors included age, preoperative comorbidities, preoperative scores of functional status (Karnofsky Performance Status [KPS] and modified Rankin Scale [mRS]), and intraoperative factors. These were analyzed against long-term care (LTC) complications, neurologic complications, systemic/infectious (SI) complications, length of stay (LOS), functional outcomes, and mortality.
Results: 286 patients were analyzed for 30 days postoperatively. Mean age was 71.8 years (range 65-92). Overall, 32% of patients experienced at least one complication and 5 patients died. When compared pre- and postoperatively, the average KPS and mRS scores improved from 78.0 to 79.8 (p <.0001) and 1.7 to 1.4 (p <.0001), respectively. Worse preoperative scores on both the KPS and mRS scale predicted increased LOS and mortality (p<0.05) but not LTC, neurologic, or SI complications.
Patients with preoperative motor deficit, altered mental status, congestive heart failure, smoking history, and chronic steroid use were all more likely to suffer a LTC complication than patients without these comorbidities. There were no meaningful associations between any preoperative variables and neurologic or SI complications. However, patients with increased anesthesia time and estimated blood loss were more likely to develop LTC, neurologic, and SI complications.
Conclusions: This study identifies factors that predict perioperative complications for patients > 65 years of age undergoing an elective craniotomy, particularly congestive heart failure, smoking history, chronic steroid use, anesthesia time, and estimated blood loss. Age alone should not preclude elective craniotomy.
Patient Care: With more patients over the age of 65 undergoing elective craniotomies, it is essential to identify risk factors within this demographic to safely choose surgical candidates in hopes of limiting perioperative complications. This research will hopefully be able to lower the overall number of complications in this age group. It also helps identify high risk patients before surgery, so patients can be optimized prior to surgery in hopes of limiting complications.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of focusing research on patients > 65 years of age due to the aging of our general population, and therefore the neurosurgical population. 2) Identify preoperative and intraoperative risk factors in patients > 65 years old undergoing elective craniotomy 3)Discuss, in small groups ways their practice may change in order to hopefully limit perioperative complications in patients > 65 years old undergoing elective craniotomy