Management Outcomes for Ruptured and Unruptured Aneurysms in the Elderly

Chung, Richard; Carter, Bob S.; Norbash, Alexander; Budzik, Ronald F; Putnam, C.; Ogilvy, Christopher S.

doi:10.1097/00006123-200010000-00006

Cited by 70 publications

(31 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is well known that both age and medical comorbidities impact outcome after CVPs. 13,24,29,37 Older age is associated with poor outcome in the setting of surgical and endovascular treatment of intracranial aneurysms 4,7,37,51 and carotid stenosis. 10,39 Patient age is also an independent predictor of death following endovascular mechanical thrombectomy procedures for acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

Wen¹,

He²,

Attenello³

et al. 2014

JNS

View full text Add to dashboard Cite

Object As health care administrators focus on patient safety and cost-effectiveness, methodical assessment of quality outcome measures is critical. In 2008 the Centers for Medicare and Medicaid Services (CMS) published a series of “never events” that included 11 hospital-acquired conditions (HACs) for which related costs of treatment are not reimbursed. Cerebrovascular procedures (CVPs) are complex and are often performed in patients with significant medical comorbidities. Methods This study examines the impact of patient age and medical comorbidities on the occurrence of CMS-defined HACs, as well as the effect of these factors on the length of stay (LOS) and hospitalization charges in patients undergoing common CVPs. Results The HACs occurred at a frequency of 0.49% (1.33% in the intracranial procedures and 0.33% in the carotid procedures). Falls/trauma (n = 4610, 72.3% HACs, 357 HACs per 100,000 CVPs) and catheter-associated urinary tract infections (n = 714, 11.2% HACs, 55 HACs per 100,000 CVPs) were the most common events. Age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs (p < 0.0001). The occurrence of HACs negatively impacts both LOS and hospital costs. Patients with at least 1 HAC were 10 times more likely to have prolonged LOS (≥ 90th percentile) (p < 0.0001), and 8 times more likely to have high inpatient costs (≥ 90th percentile) (p < 0.0001) when adjusting for patient and hospital factors. Conclusions Improved quality protocols focused on individual patient characteristics might help to decrease the frequency of HACs in this high-risk population. These data suggest that risk adjustment according to underlying patient factors may be warranted when considering reimbursement for costs related to HACs in the setting of CVPs.

show abstract

Section: Discussionmentioning

confidence: 99%

The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

Wen¹,

He²,

Attenello³

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…From various retrospective series on aneurysmal SAH in the elderly published over the past 15 years, the rates of favorable outcome varied from 50.7 to 63.3% after microsurgical clipping 8,15,18,23,47 and from 54 to 78.7% after endovascular coiling. 4,6,26,40 The single difference, when elderly patients were compared with younger patients included during the same period, was that the elderly cohort with a poor grade had a less favorable outcome than the younger patients.…”

Section: Neurological Deterioration and Outcomementioning

confidence: 99%

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Proust¹,

Gérardin

Derrey³

et al. 2010

JNS

View full text Add to dashboard Cite

Object The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context. Methods This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997–June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score ≤ 2) and unfavorable (mRS score > 2). Results Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001). Conclusions The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.

show abstract

“…[2][3][4][5][6][7][8] However, endovascular treatment is now recognized as an alternative to surgical treatment, especially for patients in poor general health and for lesions of the posterior circulation. Nevertheless, no study assessing the results of endovascular treatment in relation to age have been undertaken, and the effectiveness of embolization in elderly patients is yet to be determined.…”

mentioning

confidence: 99%