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Health & Medicine for Senior Citizens

Elderly 80+ Do As Well As Younger Patients After Open Skull Surgery for Hematoma

80-year-olds may be just as likely to return to their previous health state after surgery as those younger - with a little more rehab

Sept. 6, 2011 – Despite a popular belief that craniotomy – surgery requiring removal of part of the skull – should not be used on patients older than age 80, a new study finds these elderly patients can, with a bit more rehabilitation and hospitalization, fare as well as younger ones treated for removal of a hematoma following a head injury.

The findings of this new report are published in the Journal of Neurosurgery.

Trauma-induced intracranial hemorrhage and resulting hematoma are very serious conditions. When these pockets of blood are large their removal frequently requires craniotomy, a surgical procedure in which a portion of the skull must be removed.

 

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Craniotomy for evacuation of a hemorrhage or hematoma has long been viewed as dangerous, although outcomes have improved enormously over the last 30 years with the advent of more sophisticated imaging systems, faster diagnoses, and better surgical techniques.

In the 1980s mortality rates following this procedure ranged from 65% to 90%; in 2008 mortality rates ranged from 22% to 41%.

Early studies demonstrated age-related morbidity and mortality rates associated with the procedure, with younger patients faring far better than older ones. This led many surgeons to be cautious when deliberating whether to use the invasive procedure in patients older than 80 years of age.

The authors of this new report questioned whether better overall outcomes of this procedure would result in better outcomes in older patients. In their paper, “Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years,” Lau and colleagues show that was clearly the case.

Lau and colleagues reviewed the electronic medical records of patients treated for closed-head trauma resulting in intracranial hemorrhage and hematoma at the University of Michigan Health System within a three-year period: 2006–2009. Focusing on patients in whom craniotomy was performed to evacuate the hematoma, they identified 103 patients without comorbidities that could confound their analyses.

They then examined patient demographics, clinical characteristics, preoperative blood values, intraoperative parameters of interest, and postoperative outcomes including complications. Using multivariate logistic regression models, the authors assessed the relationship between patient age (80 years and younger vs. older than 80 years) and length of hospitalization (time spent in an intensive care unit as well as total stay), postoperative complications, morbidity, mortality, and ability to return to baseline functional status.

Of the 103 patients 27 were older than 80 years of age. The authors found that in general the older patients required significantly longer stays in the hospital, had a higher rate of postoperative complications, and were more likely to require rehabilitative services.

Despite these differences, however, there were no statistically significant differences between the age groups with respect to 30-day mortality rates or the patient’s ability to return to baseline functional status.

According to coauthor Abdulrahman M. El-Sayed, the take-away message of this paper is that patients “80 or older may be just as likely to return to their previous health state after surgery as those who are younger—meaning that they can achieve a good outcome after treatment and should be treated, barring other significant health concerns.” El Sayed adds,

“As this is not always the case when making the decision as to whether or not to treat very elderly patients with some injuries and diseases, more research that considers the effectiveness of treatments among the elderly are needed.”

This study was funded in part by grants from the Rhodes Trust and the National Institutes of Health.

Study Available online at http://www.thejns.org.

 

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