Introduction: Historically, epilepsy surgery has not been offered to patients of advanced age because of concerns for increased rates of post-operative complications and morbidity. Although no specific age cutoff has been defined, many clinical studies have excluded patients older than 50 years. Presently, there is no definitive data to support this practice. As such, our group investigated the effect of advanced age on complication rates following epilepsy surgery. We hypothesized that increasing age would be associated with an increased number of postoperative complications.
Methods: Using the Truven MarketScan database, we performed a large, retrospective, cohort study of patients 18 years or older who underwent epilepsy surgery between the years 2000 and 2011. We examined both aggregate and individual post-operative complications. Additionally, multivariate logistic regression analysis was employed to determine complication-related odds ratios for both advanced age (age 50 years or older) and increasing 5-year age epochs after adjusting for other covariates.
Results: Overall, 84 of 709 patients had a complication within 90 days of surgery. These included intracranial hemorrhage or hematoma (52 patients, 7.3%), infection (33 patients, 4.7%), pneumonia (10 patients, 1.4%), and pulmonary embolism (9 patients, 1.3%). After controlling for covariates, we found that except for pneumonia, advanced age and increase age (5-year epochs) did not correlate with higher 90-day incidence of post-operative complications (OR 1.11; 95% confidence interval 0.59-2.11; p = 0.744).
Conclusions: Older patients selected for epilepsy surgery showed a similar 90-day complication risk compared with their younger cohort. As such, our results suggest that age should not be a primary factor in determining one’s candidacy for epilepsy surgery. Instead, a clear focus on patients with medication-refractory epilepsy and their candidacy for a variety of newer neuromodulation, neuroablative and neurosurgical treatment options should allow for expansion of the traditional therapeutic window.
Patient Care: Our research demonstrates that use of advanced age as a primary exclusion criteria for epilepsy surgery is unwarranted and likely unnecessarily narrowing the therapeutic window for epilepsy surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the prevalence of epilepsy across various patient ages, 2) Identify the common post-operative complications seen with epilepsy surgery, and 3) Discuss the impact of age on these complications.