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Neurosurgery and elderly: analysis through the years

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Abstract

The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.

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Authors and Affiliations

  1. Neurosurgery Department, Lariboisiere University Hospital, Paris, France

    Salvatore Chibbaro, O. Makiese, G. Mirone, S. Hamdi, T. Spiriev, P. Di Emidio, B. George & D. Bresson

  2. Neuro-ICU/Anaesthesia Department Lariboisiere, University Hospital Paris, Paris, France

    A. C. Lukaszewicz, R. Pirracchio & D. Payen

  3. Neurosurgery Department, Necker University Hospital Paris, Paris, France

    F. Di Rocco

  4. Unité de Recherche Clinique Hôpital Universitaire Lariboisière – Fernand Widal, Paris, France

    E. Vicaut

  5. Tucson Centre for Neuroscience, Tucson, AZ, USA

    M. Marsella

  6. Neurology Department Royal London Hospital, London, UK

    B. Turner

  7. Service de Neurochirurgie, Hopital Lariboisière, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Salvatore Chibbaro

Authors
  1. Salvatore Chibbaro
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  2. F. Di Rocco
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  3. O. Makiese
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  4. G. Mirone
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  6. A. C. Lukaszewicz
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  8. B. Turner
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  9. S. Hamdi
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  10. T. Spiriev
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  12. R. Pirracchio
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  13. D. Payen
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  14. B. George
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  15. D. Bresson
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Corresponding author

Correspondence to Salvatore Chibbaro.

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Comments

Daniel Hertle, Heidelberg, Germany

Aging of the population has become a focus for researchers in all medical fields. In recent years, treatment of elderly patients is an increasing challenge for neurosurgical hospitals. For elderly neurosurgical patients, many treatment strategies have still to be defined. Chibbaro and coworkers retrospectively analyzed medical records of elderly patients over a 25-year-period. In their important article, they report a dramatic decrease in postoperative mortality rate of 12% in 1983 to 1985 compared to 0.3% in 2003 to 2005. Mean length of hospital stay was markedly reduced in the second group. They conclude that this result supports an age-independent treatment for elderly neurosurgical patients. I agree with the authors that the significance of neurosurgical treatments in elderly patients will increase in the next 25 years.

Andreas M. Stark, Kiel, Germany

The authors present clinical data from elderly patients (defined as individuals over the age of 70 years), which have been treated in a neurosurgical unit within 25 years. The topic is interesting since (1) elderly patients constitute a major and increasing proportion of the neurosurgical workload. (2) Due to advances in operative techniques and neuroanesthesia, the proportion of patients eligible for surgery is also rising. Surprisingly, relevant data are rare in the literature.

The authors present interesting epidemiological data concerning this important issue. So, they show that the proportion of elderly patients who were admitted increased from 11% to 25% during this period. Additionally, the proportion of elderly patients who underwent neurosurgical operations increased from 77% to 93%. Notably, the lengths of hospital stay and the mortality rate has been decreased significantly during this period.

This study gives valuable insight into the demographic changes in neurosurgery and underlines the need for specified treatment protocols and study designs for elderly patients.

Josef Zentner, Freiburg, Germany

It is the merit of the authors to address an important topic, since elderly patients constitute an increasing proportion in the general population and, therefore, also among neurosurgical patients. It should be stressed very clearly that the favorable outcome of elderly patients after neurosurgical operations is not only related to improved operative techniques, but also to advances in neuroanesthesia and intensive care that make elderly patients eligible for surgical treatment nowadays. This is especially true for patients with lumbar stenosis which is a typical problem of elderly patients. It is well known that these patients noticeably benefit from surgical decompression.

One should keep in mind the problem of defining the term “elderly patients”. It is well known that life expectancy has increased during the last decades. Therefore, it may be difficult to compare a 75- years old patient in 1985 with a patient of the same age in 2011. Despite this fact it seems to be important to point out that surgical options should also be offered to elderly and old patients.

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Chibbaro, S., Di Rocco, F., Makiese, O. et al. Neurosurgery and elderly: analysis through the years. Neurosurg Rev 34, 229–234 (2011). https://doi.org/10.1007/s10143-010-0301-6

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  • DOI: https://doi.org/10.1007/s10143-010-0301-6

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