Predictors of inpatient death and complications among postoperative elderly patients with metastatic brain tumors.
OBJECTIVE
Risks of brain surgery in elderly patients with brain metastases are not well defined. This study was designed to quantify the postoperative risk for these patients after brain surgery for metastatic disease to the brain.


METHODS
We performed a retrospective analysis of the Nationwide Inpatient Sample (1998-2005). Patients aged 65 years or older who underwent tumor resection of brain metastases were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included systemic postoperative complications, length of stay (LOS), and total charges.


RESULTS
A total of 4,907 patients (53.6% men) were identified. Mean age was 72.1 years. Mean Charlson comorbidity score was 7.8. Inpatient mortality was 4%. The most common adverse events were pulmonary complications (3.4%). Mean length of stay was 9.2 days. Mean total charges were $57,596.39. In multivariate analysis, patients up to age 80 years had no significantly greater odds of inpatient death, relative to their 65- to 69-year-old counterparts. Each 1-point increase in Charlson score was associated with 12% increased odds of death, 0.52 days increased LOS, and $1,710.61 higher hospital charges. Postoperative pulmonary complications, stroke, or thromboembolic events increased LOS and total charges by up to 9.6 days and $57,664.42, respectively. These associations were statistically significant (P < 0.05).


CONCLUSIONS
Surgical resection of brain metastases among the elderly up to the ninth decade of life is feasible. Age older than 80 years and higher Charlson comorbidity scores were found to be important prognostic factors for inpatient outcome. Incorporating these factors into preoperative decision making may help to select appropriately those elderly candidates for neurosurgical intervention.
Grossman
Rachel
R
Department of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mukherjee
Debraj
D
Chang
David C
DC
Purtell
Michael
M
Lim
Michael
M
Brem
Henry
H
Quiñones-Hinojosa
Alfredo
A
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome
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