gms | German Medical Science

Objective: With patient care continuously improving over time, age limits for neurosurgical interventions shift towards ever older patients in modern western countries. We investigate whether octogenarians (> 80y) stand out in outcome and incidence of perioperative complications.

Methods: We included all consecutive patients >80y operated in our department between January 2013 and August 2016 from our prospective patient registry. As control group, we selected patients aged 55-75y matched by the indication for surgery. Status at admission, indication for surgery, early perioperative complications, functional outcome and mortality were assessed. Complications were graded by their severity in the therapy-oriented Clavien-Dindo-Grading system (CDG).

Results: We compared 183 octogenarians (mean age 84y, 110 men) to 155 controls (mean age 67y, 107 men). At admission, the degree of disability and dependence was indistinguishable between age groups (mRS 2 vs. 2, p = 0.47; Karnofsky 70 vs. 80, p = 0.49). Indications for surgery were trauma (42% vs 38%), tumor (20% vs 22%), vascular (14% vs 15% controls), hydrocephalus (14% vs 15%), spinal (11% vs 10%) and movement disorder (1% vs 1%). At discharge, the clinical and functional outcome significantly favored the younger cohort (mRS 2 vs. 1; Karnofsky 80 vs. 90, both p<0.001). While complications were more frequent in octogenarians than in controls (34% vs. 25%), this difference did not reach statistical significance (p=0.073). Octogenarians with spinal pathology showed the highest complication rate (50%). The majority of complications were low grade (CDG 1-2) in both groups (74% vs. 68%). There was no difference in mortality (3.3% vs. 3.2%).

Conclusion: Frequency of severe complications, dependency and mortality was equally low in both octogenarians and controls, which supports indication for neurosurgery in the elderly.