Division of Neurosurgery, University of Toronto, Toronto, Canada.
Department of Neurosurgery, Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2019 Oct;130:e375-e382. doi: 10.1016/j.wneu.2019.06.093. Epub 2019 Jun 21.
Advances in medical care and technology have dramatically improved outcomes in patients undergoing neurosurgical intervention; however, certain patient subgroups (e.g., older adults) may encounter greater rates of morbidity and mortality in the perioperative period. The objective of this study was to determine the effects of patient and hospital characteristics, including age, on in-hospital mortality, and complication rates of 3 routine neurosurgical operations: subdural hematoma evacuation, brain tumor resection, and degenerative spine procedures.
A retrospective multivariable analysis of the 2014 National Inpatient Sample was performed. The setting was a national sample of hospitalized inpatient stays occurring in 2014 in the United States. Patients (N = 48,963) included those undergoing subdural hematoma evacuation, brain tumor resection, or degenerative spine procedures, stratified according to age group (<65, 65-74, 75-84, 85+ years). Mortality and complication rate were measured.
Age ≥85 years was found to increase the odds of mortality (odds ratio 11.32) and complications (odds ratio 2.64) in patients undergoing degenerative spine procedures, whereas age had no significant effect on mortality and complication rate in subdural hematoma evacuation and brain tumor resection. Multiple comorbidities and nonelective status were predictors of increased mortality and complication rate in all procedure groups.
Overall, our data would suggest that increased age does not universally predict worse outcome and that, for many procedures, surgical decision-making in older patients should instead consider other pertinent factors, such as comorbidities and elective status.
医疗保健和技术的进步极大地改善了接受神经外科干预的患者的预后；然而，某些患者亚组（例如老年人）在围手术期可能会遇到更高的发病率和死亡率。本研究的目的是确定患者和医院特征（包括年龄）对 3 种常规神经外科手术：硬膜下血肿清除术、脑肿瘤切除术和退行性脊柱手术的院内死亡率和并发症发生率的影响。
对 2014 年全国住院患者样本进行回顾性多变量分析。该研究的背景是 2014 年美国全国住院患者的住院患者样本。患者（N=48963）包括接受硬膜下血肿清除术、脑肿瘤切除术或退行性脊柱手术的患者，根据年龄组（<65 岁、65-74 岁、75-84 岁、85 岁以上）进行分层。测量死亡率和并发症发生率。
发现 85 岁以上的年龄会增加退行性脊柱手术患者的死亡几率（优势比 11.32）和并发症几率（优势比 2.64），而年龄对硬膜下血肿清除术和脑肿瘤切除术的死亡率和并发症发生率没有显著影响。多种合并症和非择期状态是所有手术组死亡率和并发症发生率增加的预测因素。
总体而言，我们的数据表明，年龄增加并不普遍预示着预后更差，对于许多手术，老年患者的手术决策应考虑其他相关因素，如合并症和择期状态。
