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Published on: October 15, 2021
Long-term outcome in elderly patients after operation for traumatic intracranial hemorrhage
Insights
Elderly patients with traumatic brain injury (TBI) undergoing cranial surgery had poorer outcomes, with older age being the only significant predictor. Other early factors did not correlate with long-term functional results after TBI surgery.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity in the elderly.
- Cranial operations are performed in elderly TBI patients, but outcomes data are limited.
- Understanding factors influencing outcomes is crucial for optimizing care in this vulnerable population.
Purpose of the Study:
- To examine the outcomes of elderly TBI patients who underwent cranial surgery.
- To identify early predictors of long-term functional outcome in this patient group.
Main Methods:
- Retrospective review of TBI patients aged 65 and older who had cranial surgery between 2004 and 2008.
- Data collection included demographics, injury characteristics, surgical details, and mortality.
- Long-term functional outcome was assessed using the Extended Glasgow Outcome Score (GOSE) via phone follow-up.
Main Results:
- 164 elderly TBI patients underwent cranial surgery; mean age was 79.2 years.
- In-hospital mortality was 28%, with an additional 20.1% dying within one year.
- Older age was the only factor significantly associated with unfavorable outcomes; other early factors showed no correlation.
Conclusions:
- Older age is a significant predictor of poor outcomes in elderly TBI patients undergoing cranial surgery.
- Early clinical or demographic factors, apart from age, did not reliably predict long-term functional recovery.
- Further research may be needed to identify other modifiable factors influencing outcomes in this population.
Objective:
This study examined outcomes in elderly TBI patients who underwent a cranial operation.
Methods:
We identified TBI patients > or = 65 who underwent a cranial operation from January 1, 2004 to December 31, 2008. Data collected included: age, admission GCS, mechanism of injury, ISS, Head AIS, type of operation, hemorrhage acuity, time to operation, pre-hospital warfarin or clopidogrel, and in-hospital death. Survivors were contacted by phone to determine an Extended Glasgow Outcome Score (GOSE). A favorable outcome was defined as having a GOSE of > or = 5 at follow-up, an unfavorable outcome was defined as: in-hospital death, death within one year of injury, and a GOSE < 5 at follow-up. Chi-square and student's t-test were used.
Results:
One hundred sixty-four elderly TBI patients underwent cranial surgery. Mean age was 79.2 +/- 7.6 years. Most patients: had a ground level fall (86.0%), suffered a subdural hematoma (95.1%), and underwent craniotomy (89.0%). Twenty-eight percent died in the hospital and another 20.1% died within one year. Fifty-six patients were eligible for a GOSE interview of these: 17 were lost to follow-up, seven refused the GOSE interview, 22 had a GOSE > or = 5, and ten had a GOSE < 5. Mean follow-up was 42.6 +/- 14.9 months. Of all the factors analyzed, only older age was associated with an unfavorable outcome.
Conclusions:
While age was associated with outcome, we were unable to demonstrate any other early factors that were associated with long-term functional outcome in elderly patients that underwent a cranial operation for TBI.
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