Impact of age on 30-day postoperative outcome of surgery for ruptured and unruptured intracranial aneurysms.
OBJECTIVE
To assess in a retrospective analysis of a prospectively collected database, the impact of increased age on 30-day postoperative outcomes of surgery for intracranial aneurysms (ICAs).


METHODS
721 adult patients who underwent surgery for ICA were identified in the 2006-2012 American College of Surgeons' National Surgical Quality Improvement Program. Baseline characteristics and 30-day outcomes were stratified by age: <50 years (n=221), 50-60 years (n=221), and >60 years (n=266). Patients <50 and 50-60 years old were propensity score-matched to those aged >60 years. Logistic regression was used to examine the relationship between increased age and surgical outcome.


RESULTS
In unadjusted analyses, age <50 years was associated with fewer postoperative complications (OR=0.5, 95% CI 0.3 to 0.7) and lower mortality (OR=0.4, 95% CI 0.2 to 0.9) compared with those aged >60 years. Patients aged between 50 and 60 years were less likely to have complications (OR=0.6, 95% CI 0.4 to 0.8) in unadjusted analyses. Upon propensity score matching, covariate balance was achieved for all age strata. In adjusted analyses, patients <50 years (OR=0.4, 95% CI 0.2 to 0.7) and 50-60 years (OR=0.5, 95% CI 0.3 to 0.8) of age continued to have fewer complications than those aged >60.


CONCLUSIONS
Age >60 is independently associated with 30-day postoperative morbidity in patients undergoing surgery for ICA. The results of this study suggest age >60 should be considered an a priori risk factor in surgical management of ICA, regardless of associated comorbidities often associated with increased age.
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Nima
N
Alan
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA.
Andreea
A
Seicean
Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Sinziana
S
Seicean
Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Warren R
WR
Selman
Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Nicholas C
NC
Bambakidis
D000328:Adult; D000367:Age Factors; D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*
Aneurysm; Complication; Hemorrhage; Subarachnoid