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

Clinical article

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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.

Abbreviations used in this paper: BMI = body mass index; GCS = Glasgow Coma Scale; ICU = intensive care unit.

Article Information

Address correspondence to: Abdulrahman M. El-Sayed, B.S., Department of Epidemiology, Columbia University, 722 West 168th Street, 15th Floor, New York, New York 10031. email: ame2145@columbia.edu.

Please include this information when citing this paper: published online August 26, 2011; DOI: 10.3171/2011.7.JNS11396.

© AANS, except where prohibited by US copyright law.

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    Comparison of postoperative complication rate by category between patients > 80 versus ≤ 80 years old with closed head injury who underwent craniotomy for evacuation of hematoma. *Infection was the only category with a statistically significant difference in rate of complications (p = 0.005). The difference in rate for cardiac complications was close to being significant (p = 0.089); the rates for reoperation (p = 0.950), neurological complications (p = 0.979), and other complications (p = 0.829) were not.

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