title: Neurosurgical Care in the Elderly: Increasing Demands Necessitate Future Healthcare Planning.
abstract: OBJECTIVE
  The worldwide elderly population is steadily increasing. It has been recommended that age-appropriate information should be available for older patients, but little exists in neurosurgery. We aim to better understand the clinical characteristics, bed occupancy and outcomes of elderly patients admitted to a UK neurosurgical unit.
  
  
  METHODS
  Retrospective review of medical records of all patients aged 75 years and older admitted for at least 1 night to the Southwest Neurosurgery Centre from 2007 to 2010. Mortality data up to 31 December 2012 were obtained from a national registry.
  
  
  RESULTS
  Eight hundred and eighty-six elderly patients were admitted, for whom 877 records were available. Three hundred and eighty-nine patients were admitted electively; 488 were emergency or urgent; 48.8% had cranial pathology and 50.7% had spinal disease. Emergency cases were significantly older and more likely to be male than elective patients. The median length of stay for emergency patients was significantly longer than that of elective patients (P < 0.0001, 3 vs. 8 days). One elective patient died as an inpatient, compared with 46 emergency patients. Of emergency and elective patients, 25.6% and 3.6%, respectively, had died by 6 months after discharge. Age and length of stay were not associated with early death.
  
  
  CONCLUSIONS
  The demographics and outcomes of the elderly admitted to a UK neurosurgical center are discussed. Differences between elective and emergency groups are attributable to both the pathologic processes and case selection. Neurosurgical treatment should not be denied based on age, however the high risks of emergency surgery in this age group should be acknowledged.
authors.affiliation: South West Neurosurgery Centre, Plymouth Hospitals NHS Trust, Plymouth, UK. Electronic address: kathrin.whitehouse@nhs.net.
authors.forename: Kathrin Joanna
authors.initials: KJ
authors.lastname: Whitehouse
authors.affiliation: Department of Neurosurgery and Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK.
authors.forename: Deva Sanjeeva
authors.initials: DS
authors.lastname: Jeyaretna
authors.affiliation: Institute of Health Research, University of Exeter, Exeter, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Wright
authors.affiliation: South West Neurosurgery Centre, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Whitfield
mesh_terms: D000367:Age Factors; D000368:Aged / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D003244:Consciousness Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006285:Health Planning; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009493:Neurosurgery / Q000639:trends; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Aged; Elderly; Neurosurgery