Craniotomy for Intracranial Aneurysm and Subarachnoid Hemorrhage

Stachniak, Joseph; Layon, A. Joseph; Day, Arthur L.; Gallagher, T. James

doi:10.1161/01.str.27.2.276

Cited by 50 publications

(22 citation statements)

References 17 publications

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“…21 It has been reported that the average craniotomy procedure itself costs $15,867 at high-volume centers. 21 Nevertheless, taken with findings that have demonstrated that quality-of-life scores remain high for elderly survivors after undergoing craniotomy for intracranial hemorrhage, 30 our findings suggest that with some added care, patients over the age of 80 may recover as successfully as younger patients and that these costs may be warranted among this population. Our findings also demonstrated that age greater than 80 years predicted the need for rehabilitation after undergoing craniotomy.…”

Section: (Continued)supporting

confidence: 64%

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Lau

El-Sayed

Ziewacz

et al. 2012

JNS

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Object Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. Methods A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. Results Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29–25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13–9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

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Section: (Continued)supporting

confidence: 64%

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Lau

El-Sayed

Ziewacz

et al. 2012

JNS

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“…The cost of treating aneurysmal SAH has been reported to increase with age 30 and clinical grade on admission. 31 With decreasing healthcare budgets and a constantly aging population, priorities must be made to ensure that money is spent in the best possible manner.…”

Section: Cost-effectiveness and Ethicsmentioning

confidence: 99%

Changes in Intervention and Outcome in Elderly Patients With Subarachnoid Hemorrhage

Johansson

Cesarini

Contant

et al. 2001

Stroke

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Background and Purpose — The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage. Methods — Two hundred eighty-one patients ≥65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998. Results — The volume of elderly patients (≥65 years of age) increased with time, especially patients ≥70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients. Conclusions — Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.

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“…In many developed countries, SAH after of 70 years of age has been a frequent pathology. 1,2,15,16,21,23,30,32,33 Some authors believe that there is not a persistent increase of rupture risk. They argue that a maximum level is reached by the age of 70 years, and then a decrease is expected.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment for Unruptured Intracranial Aneurysms in Elderly Patients: Single-Center Report

Hwang¹,

Hwang²,

Oh³

et al. 2011

AJNR Am J Neuroradiol

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Craniotomy for Intracranial Aneurysm and Subarachnoid Hemorrhage

Cited by 50 publications

References 17 publications

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Changes in Intervention and Outcome in Elderly Patients With Subarachnoid Hemorrhage

Endovascular Treatment for Unruptured Intracranial Aneurysms in Elderly Patients: Single-Center Report

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