Neurosurgery in Octogenarians: A Prospective Study of Perioperative Morbidity, Mortality, and Complications in Elderly Patients.

Abstract

The aging population in industrialized countries shifts the age limit for neurosurgical interventions toward increasingly older patients. This study investigates whether octogenarians (≥80 years) stand out in outcome and incidence of perioperative complications. Consecutive patients ≥80 years operated on between January 2013 and August 2016 were compared against a control group of patients aged 55-75 years matched by indication for surgery. Status at admission, perioperative complications, functional outcome, and mortality were assessed in a prospective patient registry. Complications were classified in the therapy-oriented Clavien-Dindo grading (CDG) system. We compared 266 octogenarians (median age, 83 years; interquartile range, 81-86 years; 154 men) with 232 controls (median age, 67 years; interquartile range, 60-71 years; 151 men). At follow-up (median, 53 vs. 49 days), median modified Ranking Scale scores were 2 versus 1 and median Karnofsky Performance Status was 80 versus 90; both improved significantly compared to baseline (P < 0.0001). Only admission Karnofsky Performance Status was significantly associated with clinical outcome at follow-up (odds ratio, 1.05; P < 0.0001). Pharmacologic treatment (CDG 2) was sufficient in 56% of all complications in octogenarians (controls, 43%). Octogenarians were more prone to complications as an inpatient (36% vs. 28%; P = 0.04) because of a higher incidence of CDG 2 complications (20% vs. 12%; P = 0.02). The rate of complications that required more extensive therapy did not differ significantly between cohorts. Neurosurgery in octogenarians had a similar rate of severe complications, morbidity, and mortality as in matched controls. Therefore, age alone should not serve as a contraindication for neurosurgery.