Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery

Bligh, Emily R; Sinha, Priyank; Smith, Daisy; Al‐Tamimi, Yahia

doi:10.1016/j.wneu.2019.09.121

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…The increased time to recurrence was also implicated in poorer performance status following a second operation. The patients with a longer time to recurrence would be older at the time of their second surgery, and with less ‘brain resilience’ and capacity for neurological recovery; this may explain the deterioration [ 33 ]. In the context of high complication rates and subsequent poorer performance status, surgeons should carefully consider the risk to benefit ratio of a second operation for recurrence, especially in the absence of symptoms that are affecting quality of life and neurological function.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Richardson

Gillespie

Mustafa

et al. 2021

Cancers

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The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Richardson

Gillespie

Mustafa

et al. 2021

Cancers

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“…Various studies have described outcomes in elderly patients following neurosurgical procedures, although the age for inclusion varies across those studies. 4,5,7,11,12,16 Schär et al reported an overall 30-day mortality rate of 0.68% in elderly patients (≥ 65 years of age) undergoing elective cranial surgery. 4 Bligh et al found a 30-day mortality rate of 0.8% in elderly patients (≥ 70 years of age) following any elective neurosurgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of "elderly" is inconsistent across studies. 4,5,12 We defined elderly patients as those who were 65 years of age or older. We grouped patients into two discrete age cohorts: 65-74 years (group 1) and 75 years or older (group 2).…”

Section: Methodsmentioning

confidence: 99%

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Magnetic resonance–guided laser interstitial thermal therapy for brain tumors in geriatric patients

Ginalis¹,

Danish²

2020

Neurosurgical Focus

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OBJECTIVEThere is a paucity of studies assessing the use of MR-guided laser interstitial thermal therapy (LITT), specifically in the elderly population. The aim of this study was to evaluate the safety of LITT for brain tumors in geriatric patients.METHODSGeriatric patients (≥ 65 years of age) treated with LITT for intracranial tumors at a single institution between January 2011 and November 2019 were retrospectively identified. The authors grouped patients into two distinct age cohorts: 65–74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded for each patient.RESULTSFifty-five geriatric patients underwent 64 distinct LITT procedures for brain tumors. The majority of lesions (40 [62.5%]) treated were recurrent brain metastases or radiation necrosis. The median modified frailty index was 0.1 (low frailty; range 0–0.4) for patients in group 1 and 0.2 (intermediate frailty; range 0–0.4) for patients in group 2 (p > 0.05). The median hospital length of stay (LOS) was 1 day (IQR 1–2 days); there was no significant difference in LOS between the age groups. The hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (43 [68.3%] of 63 cases) were fit for discharge to their preoperative accommodation following LITT. The rate of discharge to home was not significantly different between the age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1% of cases) were found to have acute neurological complications following LITT, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (1 case). The complication and 30-day postoperative mortality rates were not significantly different between the two age groups.CONCLUSIONSLITT can be considered a minimally invasive and safe neurosurgical procedure for the treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential, because neurosurgeons are treating an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT without considering frailty and comorbidities.

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“…However, recent years have seen a paradigm shift away from viewing age alone as a cutoff for treatment, but instead incorporating functional/performance status into surgical decision-making. 5 When considering the latter, ABBREVIATIONS cSDH = chronic subdural hematoma.…”

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confidence: 99%

Ethical issues in geriatric cranial neurosurgery

Hachem

Bernstein

2020

Neurosurgical Focus

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The global demographic shift to an older population has led to the emergence of the new field of geriatric neurosurgery. Beyond the complexities of disease states and multimorbidity, advanced age brings with it intricate ethical issues pertaining to both the practice and provision of medical and surgical care. In this paper, the authors describe the central ethical themes seen across the spectrum of common neurosurgical conditions in the elderly and highlight the use of foundational ethical principles to help guide treatment decision-making.

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Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery

Cited by 8 publications

References 25 publications

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Magnetic resonance–guided laser interstitial thermal therapy for brain tumors in geriatric patients

Ethical issues in geriatric cranial neurosurgery

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