Neurosurgery in octogenarians

Abstract

Introduction. The developed world has an aging population with an increasing neurosurgical demand. The benefit of neurosurgical intervention in the octogenarian population and the outcome is unclear. The 2010 NCEPOD report on all surgical care for the elderly (> 80 years) concluded that extreme age was an additional risk for which care was often lacking. Methods. Retrospective case review of 134 octogenarian admissions to a regional neurosurgical unit from January to December 2010. Admission pathology, co-morbidities, delay to surgery, length of stay, discharge destination, functional outcome and mortality were assessed. Results. There were 49 elective and 81 emergency admissions. Of which, 51% of elective admissions were for degenerative spine and 20% for functional/pain disorders. Also 55% of emergency admissions were for cranial trauma. Co-morbidities and ASA grade were higher in the emergency group. Peri-operative mortality was 0% for elective admission and 10.4% for emergency patients. Outcome following cranial trauma was good in 62% of patients. Degenerative spine outcome was good in 69% of patients. All patients with pain/functional pathology had immediate initial improvement but 56% had recurrence of pain at 6 months. 88% of elective admissions and 22% of emergency admissions were discharged directly to home with a mean length of stay of 7 days for elective and 13 days for emergency patients. Conclusions. Patient selection is crucial when considering neurosurgery in the octogenarian population. Our octogenarian patients had higher complication rate and 30-day mortality than those < 80 year old, demonstrating the additional risk and need for enhanced peri-operative care.

Keywords::

• age and outcome
• complications
• elderly
• neurosurgery
• outcome
• octogenarians

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.