Craniotomy for intracranial aneurysm and subarachnoid hemorrhage : is course, cost, or outcome affected by age ?

• Published in: Stroke (1970) Vol. 27; no. 2; pp. 276 - 281
• Main Authors: STACHNIAK, J. B, LAYON, A. J, DAY, A. L, GALLAGHER, T. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-02-1996; American Heart Association, Inc
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Costs and Cost Analysis; Craniotomy - economics; Craniotomy - mortality; Critical Care; Disabled Persons; Female; Follow-Up Studies; Humans; Intracranial Aneurysm - surgery; Male; Medical sciences; Middle Aged; Morbidity; Neurosurgery; Quality of Life; Skull, brain, vascular surgery; Subarachnoid Hemorrhage - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Human; Intracranial; Nervous system diseases; Costs; Aneurysm; Cardiovascular disease; Hemorrhage; Cerebral disorder; Quality of life; Vascular disease; Treatment; Surgery; Health economy; Central nervous system disease; Subarachnoid; Complication; Craniotomy; Evolution; Cerebrovascular disease; Age
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.27.2.276

Age may influence cost or effectiveness of treatment for subarachnoid hemorrhage (SAH). This study examined the effect of age on both.
Patients (n = 219) who underwent craniotomy for intracranial aneurysm and SAH over 6 years at one tertiary care center were divided in two ways by age: single advanced age (< 65 years and > or = 65 years) and decade of age (23 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 81 years). Data recorded for each patient included numbers of procedures and complications in the surgical intensive care unit (SICU), number of days in the SICU and the hospital, costs for SICU and ward care, total cost (SICU plus ward costs), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission and discharge, the Hunt-Hess grade at admission and immediately preoperatively, and quality of life score, a measure of outcome. Mortality rates by age group were calculated.
The only variable significantly affected by decade of age was mortality rate, which increased as decade of age increased (3% to 17%). With the 65-year comparison, mortality rate, cost, APACHE II score at admission and discharge, days before operation, and days in the SICU were significantly higher for age > or = 65 years.
Whereas mortality is higher for the older age group, quality of life scores appear acceptable for those who survive. Even though the hospital costs of treating elderly patients for SAH may be higher than those for younger patients, this should not be used to justify withholding care from the elderly.