Brain Tumor Surgery is Safe in Octogenarians and Nonagenarians: A Single-Surgeon 741 Patient Series
Brain Tumor Surgery is Safe in Octogenarians and Nonagenarians: A Single-Surgeon 741 Patient Series
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DOI：
10.1016/j.wneu.2019.08.219
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发表时间：
2019-12-01
影响因子：
2
通讯作者：
Komotar, Ricardo J.
中科院分区：
文献类型：
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作者：
Eichberg, Daniel G.;Di, Long;Komotar, Ricardo J.
目的：由于假设围手术期发病率和死亡率风险更高，因此通常不向具有手术可及性脑肿瘤的老年患者提供临床指征的脑肿瘤手术（BTS）。由于脑肿瘤的发病率在老年人群中最高，并且由于全球人口正在老龄化，因此准确了解老年患者的BTS风险至关重要。我们的目的是比较安全的BTS在老年患者与年轻的同行，以更好地了解BTS的风险-效益概况为老年patients.METHODS：回顾性队列研究的年轻（20 - 29岁），老年（60 - 79岁），老年（80岁以上）患者接受BTS与一个单一的神经外科医生。记录术前和术后改良兰金评分（Delta mRS）、住院时间（洛）、并发症发生率和30天再入院率（30 DRR）之间的差异。不同年龄组之间术前mRS无显著差异，卡方（2）= 0.269，P = 0.874。老年并发症发生率为6.0%，与年轻（4.5%，P = 0.667）或老年（7.2%，P = 0.696）并发症发生率无显著差异。老年洛为1.93 +/-SD 0.176天;与年轻人（3.01 +/-0.384天，P = 0.081）或老年人（2.47 +/-0.144天，P = 0.881）无显著差异。统计等效性检验显示，95%的置信度，有等效性在Delta mRS之间的年龄groups.CONCLUSIONS：老年患者没有显着不同的Delta mRS，洛，30 DRR，或并发症发生率BTS后与年轻的同行相比。因此，在健康患者中，高龄不应阻止患者接受BTS治疗。
OBJECTIVES: Elderly patients with surgically accessible brain tumors are often not offered clinically indicated brain tumor surgery (BTS) because of to assumptions of greater risk for perioperative morbidity and mortality. Because brain tumor incidence is highest in the geriatric population, and because the global population is aging, accurate understanding of BTS risk in elderly patients is critical. We aimed to compare safety of BTS in elderly patients with younger counterparts to better understand the risk-benefit profile of BTS for elderly patients.METHODS: Retrospective cohort study of young (20-29 years), senior (60-79 years), and elderly (80+ years) patients who underwent BTS with a single neurosurgeon. Differences between pre- and postoperative modified Rankin score (Delta mRS), length of hospitalization (LOH), complication rate, and 30-day readmission rates (30DRR) were recorded.RESULTS: A total of 741 patients (83 elderly, 570 senior, and 88 young) were identified. No significant difference in preoperative mRS between different age groups, chi(2) = 0.269, P = 0.874. Elderly complication rate was 6.0%, not significantly different from young (4.5%, P = 0.667) or senior (7.2%, P = 0.696) complication rate. Elderly LOH was 1.93 +/- SD 0.176 days; not significantly different from young (3.01 +/- 0.384 days, P = 0.081) or senior (2.47 +/- 0.144 days, P = 0.881). Statistical equivalence testing showed with 95% confidence that there was equivalence in Delta mRS among age groups.CONCLUSIONS: Elderly patients did not have significantly different Delta mRS, LOH, 30DRR, or complication rates after BTS compared with younger counterparts. Therefore, in healthy patients, advanced age alone should not prevent patients from being offered BTS.