Artikel
Meningioma surgery in geriatric and young patients. Influence of preoperative features on mobidity and mortality
Chirurgie der Meningeome bei geriatrischen und jungen Patienten. Einfluss präoperativer Faktoren auf Morbidität und Mortalität
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Surgery of meningiomas in geriatric patients is known to be complicated by a higher risk due to different conditions. To evaluate the morbidity and mortality after menigioma surgery, we compared patients older than 65 years with younger controls.
Methods
The retrospective study included 52 elderly patients and 52 equivalent patients younger than 65 years, who were operated in our department between 1994 and 2003. We analysed demographic data, tumour size and location, ASA score, neurological status and Karnovsky-scale pre- and postoperatively, operative complications and days to discharge after operation.
Results
There was a significant difference in tumour size (elderly>young; p<0,01) and expected significant data were found for ASA score and Karnovsky-scale between the groups. The days to discharge revealed a value of p=0,071 (elderly>young). Significant correlations were seen for tumour size and days to discharge in both groups. After surgery we found no significant changes of the Karnovsky-scale in both groups. Time to discharge was not significantly correlated to age, but in the elderly to the preoperative Karnovsky-scale (r=-0,29; p<0,05). Before surgery 28,8% of the young and 71,2% of the geriatric patients had neurological symptoms. After surgery 17,3% of the young patients revealed new neurological deficits, compared to 9,6% of the elderly. The new symptoms were in 78,6% related to skull base meningioma surgery. Postoperative haematomas were only seen in the geriatric group (5,8%). Three patients (>65 years) died within 30 days after surgery due to postoperative haematoma (1,9%) or pulmonary embolism caused by deep vein thrombosis (3,8%). No dead in the young was recognised.
Conclusions
There is a higher mortality rate in the elderly compared to the young due to non-surgical complications and the higher risk of a postoperative haematoma. In our analysis the morbidity related to a deterioration of the neurological status after surgery was pronounced in the young and related to unfavourable tumour site. In contrast there was already an increased rate of neurological symptoms before surgery in the elderly, probably due to a greater tumour size. Higher age does not exclude an operation.