University of Michigan Medical School, Ann Arbor, Michigan, USA.
J Neurosurg. 2012 Jan;116(1):234-45. doi: 10.3171/2011.7.JNS11396. Epub 2011 Aug 26.
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.
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.
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.
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.
在过去几十年中，创伤性颅内血肿和出血（硬膜外、硬膜下和脑实质内出血）的治疗方法不断进步，使这些情况下的生存率得到提高。然而，关于患者年龄与这些情况下手术治疗结果之间关系的研究很少。在这项研究中，作者研究了 80 岁以上患者与闭合性颅脑损伤和颅内出血开颅术后结局之间的关系。
作者确定了 2006 年至 2009 年期间因闭合性颅脑损伤而行紧急开颅清除颅内血肿的连续人群。使用多变量逻辑回归模型，作者评估了年龄（>80 岁与≤80 岁）与术后并发症、重症监护病房停留时间、住院时间、发病率和死亡率之间的关系。
在 103 例患者中，27 例年龄大于 80 岁，76 例年龄为 80 岁或以下。年龄较大与住院时间延长（p=0.014）、并发症发生率较高（OR 5.74，95%CI 1.29-25.34）和需要康复治疗的可能性较高（OR 3.28，95%CI 1.13-9.74）相关。然而，两组在 30 天死亡率或恢复到功能基线状态的能力方面无统计学差异。
这些发现表明，与年轻患者相比，80 岁以上的患者可能同样能够恢复到受伤前的功能基线，但可能需要更多的术后医疗关注，如康复治疗和延长住院时间。需要进行前瞻性研究，以探讨年龄、围手术期参数与颅内出血开颅术后结局之间的关系。尽管如此，本研究的结果可能会为颅内出血老年患者的护理提供更明智的决策。
