Abstract SNACC-93

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PERIOPERATIVE FACTORS AND OUTCOME IN ELDERLY PATIENTS UNDERGOING INTRACRANIAL SURGERY- A PROSPECTIVE OBSERVATIONAL STUDY

Kumar S, Pandia M, Chaturvedi A, Dube S
All India Institute of Medical Sciences, New Delhi, Delhi, India

INTRODUCTION:Elderly patients going for neurosurgery pose special challenges because of associated commorbidities, age-related pathophysiologic changes in addition to specific problems related to neurosurgical conditions like poor preoperative Glasgow coma scale, lower cranial nerve palsies, raised intracranial pressure, intraoperative brain stem handling and major blood loss. As the data of perioperative factors of neurosurgical patients in elderly population is is scarce(1) , we did this prospective observational study to assess various perioperative factors in this group of patients and their influence on the outcome of surgery.
MATERIALS AND METHOD:After taking approval from the ethics committee, elderly patients of age more than or equal to 60 years undergoing neurosurgical procedures were studied prospectively. Information related to history, physical examinations, investigation reports, perioperative events and outcome at discharge of the patients were recorded. Univariate and multivariate analysis were performed for finding associated risk factors for poor outcome (Glasgow outcome scale ≤3)
RESULTS:Data was analyzed in 101 patients .Out of 101 patients, there were 40 female patients. The mean age of the patients was 66.05 years. Sixty nine patients were good grade Amreican Society of Anesthesiolgists ( ASA) ( ASA 1 and ASA 2) and 32 were poor grade ASA (ASA 3 and ASA 4) . Twenty nine patients were operated on emergency basis. Hypertension was most common comorbidity in 62 patients, followed by diabetes in 20 patients. Various surgical procedures were for tumour resection (47), hematoma evacuation (17), vascular surgeries (16) and other procedures (20). Hemodynamic fluctuations were the most common intraoperative complications (28 patients). Electrolyte abnormality was the most common postoperative complication seen in 45 patients. Twenty four patients had poor outcome at hospital discharge. Univariate analysis showed that various factors associated with poor outcome are vascular surgeries, preoperative poor Glasgow coma scale, emergency surgery, raised intracranial pressure, intraoperative blood loss, blood transfusion, intraoperative brain bulge, intraoperative hemodynamic fluctuations and postoperative complications like respiratory, cardiovascular and electrolyte abnormalities. Multivariate logistic regression analysis showed vascular surgeries , preoperative Glasgow coma scale < 8, blood loss >2 litres as independent risk factors for poor neurological outcome at hospital discharge.
CONCLUSION:Presence of systemic illness like hypertension and diabetes were common in our patients. Hemodynamic fluctuations were the most common intraoperative complication, while electrolytes abnormality was the most common postoperative complication seen. The independent risk factors for poor outcome at hospital discharge were preoperative Glasgow coma scale <8 , vascular surgery and blood loss >2 litres .
KEYWORDS: Glasgow outcome scale, elderly patients, perioperative complications .
REFERENCES:
1. Stark AM, Hedderich J, Held-Feindt J, Mehdorn HM (2007) Glioblastoma–the consequences of advanced patient age on treatment and survival. Neurosurg Rev 30(1):56–61, discussion 61–62





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