Johans Stephen J, Garst Jonathan R, Burkett Daniel J, Grahnke Kurt, Martin Brendan, Ibrahim Tarik F, Anderson Douglas E, Prabhu Vikram C
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA.
World Neurosurg. 2017 Nov;107:216-225. doi: 10.1016/j.wneu.2017.07.177. Epub 2017 Aug 7.
Neurosurgical patients are aging as the general population is becoming older.
A retrospective review of patients ≥65 years of age who underwent an elective craniotomy from 2007 to 2015 to identify risk factors for 30-day morbidity/mortality was conducted. Key preoperative variables included age, comorbidities, and functional status based on the Karnofsky Performance Status score and modified Rankin Scale score. Outcome variables included long-term care (LTC) complications, neurologic complications, systemic/infectious complications, length of stay, functional outcomes, and mortality.
A total of 286 patients ≥65 years underwent elective craniotomy at Loyola University Medical Center over 8 years. Seventy-two patients had a preoperative neurologic deficit and 95 had a systemic morbidity before surgery. Postoperative neurologic and systemic morbidity was 14% and 23%, respectively. 7% of patients experienced a LTC complication and 5 patients (1.7%) died. Worse preoperative scores on both the Karnofsky Performance Status and modified Rankin Scale predicted increased length of stay and mortality (P < 0.05). Univariable and multivariable analyses showed that patients with preoperative motor deficit, altered mental status, congestive heart failure, smoking history, and chronic steroid use were all more likely to have an LTC complication, and increased anesthesia time and estimated blood loss increased risk for LTC, neurologic, and systemic/infectious complications.
This study identifies factors that predict perioperative complications for elderly patients undergoing elective craniotomies, particularly congestive heart failure, smoking history, chronic steroid use, anesthesia time, and estimated blood loss. Age alone should not preclude elective craniotomy.
随着普通人群老龄化，神经外科患者也在老龄化。
对2007年至2015年接受择期开颅手术的65岁及以上患者进行回顾性研究，以确定30天发病率/死亡率的危险因素。术前关键变量包括年龄、合并症以及基于卡诺夫斯基表现状态评分和改良Rankin量表评分的功能状态。结果变量包括长期护理（LTC）并发症、神经并发症、全身/感染性并发症、住院时间、功能结局和死亡率。
8年间，共有286例65岁及以上患者在洛约拉大学医学中心接受了择期开颅手术。72例患者术前存在神经功能缺损，95例患者术前存在全身疾病。术后神经和全身疾病的发生率分别为14%和23%。7%的患者出现LTC并发症，5例患者（1.7%）死亡。卡诺夫斯基表现状态和改良Rankin量表术前评分较差预示住院时间延长和死亡率增加（P<0.05）。单变量和多变量分析显示，术前存在运动功能缺损、精神状态改变、充血性心力衰竭、吸烟史和长期使用类固醇的患者更有可能发生LTC并发症，麻醉时间延长和估计失血量增加会增加LTC、神经和全身/感染性并发症的风险。
本研究确定了预测老年患者择期开颅手术围手术期并发症的因素，特别是充血性心力衰竭、吸烟史、长期使用类固醇、麻醉时间和估计失血量。仅年龄不应排除择期开颅手术。
