Does Age Influence the Poor Prognosis after Aneurysmal SAH Surgery in Elderly Patients?.

Sim, Jong Eun; Kim, Hyung Dong; Song, Young Jin; Noh, Seung Jin

Original Article

Journal of Korean Neurosurgical Society 2006;40(5): 357-362.

Jong Eun Sim, Hyung Dong Kim, Young Jin Song, Seung Jin Noh

Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea. hdkim@donga.ac.kr

ABSTRACT

OBJECTIVE
The incidence of aneurysmal subarachnoid hemorrhage has been increasing. At the same time, surgical results for elderly patients are unsatisfactory and no guidelines of treatment are available. We carried out a study comparing variable factors and surgical results between young and old age groups to find ways to improve prognosis.
METHODS
A retrospective study was carried out on 754 patients who were operated on between 1990 and 2004 by the same surgeon in our hospital. The patients were divided into seven groups according to age: 93 patients below 40 years of age (Group I), 419 patients aged 40~59 (Group II), 115 patients aged 60~64 (Group III), 82 patients aged 65~69 (Group IV), 28 patients aged 70~74 (Group V), 12 patients aged 75~79 (Group VI) and 5 patients over the age of 80 (Group VII). We then checked their medical history, Fisher's grade, Hunt-Hess grade, postoperative complications, and Glasgow Outcome Scale.
RESULTS
Age was not a statistically significant factor among patients below 70 years of age (P value> or =0.05). But for those aged 70 and older, the age factor had a statistical value (P value< or =0.001). In addition, there was a close correlation between Hunt-Hess grade IV and V patients, and those with vasospasm, and hydrocephalus after surgery, with poor prognosis in elderly patients as well as young patients (P value< or =0.001).
CONCLUSION
Advanced age (under the age of 70) dose not precluded adequate surgical treatment in patient with AN SAH, and we should be also alert to preventable causes of delayed neurological deterioration for improving the outcome in all elderly groups.

Key Words: Prognosis factors; SAH; Elderly patients