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(Stroke. 1996;27:276-281.)
© 1996 American Heart Association, Inc.

Articles

Craniotomy for Intracranial Aneurysm and Subarachnoid Hemorrhage

Is Course, Cost, or Outcome Affected by Age?

Presented in part at the Congress of Neurological Surgeons, San Francisco, Calif, October 14-19, 1995.

Joseph B. Stachniak, MD; A. Joseph Layon, MD; Arthur L. Day, MD T. James Gallagher, MD

From the Departments of Anesthesiology (J.B.S., A.J.L., T.J.G.), Medicine (A.J.L.), Neurosurgery (J.B.S., A.L.D.), and Surgery (T.J.G., A.J.L.), University of Florida College of Medicine (Gainesville).

Correspondence to Editorial Office, A.J. Layon, MD, Department of Anesthesiology, University of Florida College of Medicine, Box 100254, Gainesville, FL 32610-0254. E-mail edit.anest2@wpo.health.ufl.edu.

Background and Purpose Age may influence cost or effectiveness of treatment for subarachnoid hemorrhage (SAH). This study examined the effect of age on both.

Methods Patients (n=219) who underwent craniotomy for intracranial aneurysm and SAH over 6 years at one tertiary care center were divided in two ways by age: single advanced age (<65 years and 65 years) and decade of age (23 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 81 years). Data recorded for each patient included numbers of procedures and complications in the surgical intensive care unit (SICU), number of days in the SICU and the hospital, costs for SICU and ward care, total cost (SICU plus ward costs), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission and discharge, the Hunt-Hess grade at admission and immediately preoperatively, and quality of life score, a measure of outcome. Mortality rates by age group were calculated.

Results The only variable significantly affected by decade of age was mortality rate, which increased as decade of age increased (3% to 17%). With the 65-year comparison, mortality rate, cost, APACHE II score at admission and discharge, days before operation, and days in the SICU were significantly higher for age 65 years.

Conclusions Whereas mortality is higher for the older age group, quality of life scores appear acceptable for those who survive. Even though the hospital costs of treating elderly patients for SAH may be higher than those for younger patients, this should not be used to justify withholding care from the elderly.

Key Words: aged • craniectomy • costs and cost analysis • quality of life • subarachnoid hemorrhage

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