Brain Tumor Surgery is Safe in Octogenarians and Nonagenarians: A Single-Surgeon 741 Patient Series

Abstract

Objectives: Elderly patients with surgically accessible brain tumors are often not offered clinically indicated brain tumor surgery (BTS) because of to assumptions of greater risk for perioperative morbidity and mortality. Because brain tumor incidence is highest in the geriatric population, and because the global population is aging, accurate understanding of BTS risk in elderly patients is critical. We aimed to compare safety of BTS in elderly patients with younger counterparts to better understand the risk-benefit profile of BTS for elderly patients.

Methods: Retrospective cohort study of young (20-29 years), senior (60-79 years), and elderly (80+ years) patients who underwent BTS with a single neurosurgeon. Differences between pre- and postoperative modified Rankin score (ΔmRS), length of hospitalization (LOH), complication rate, and 30-day readmission rates (30DRR) were recorded.

Results: A total of 741 patients (83 elderly, 570 senior, and 88 young) were identified. No significant difference in preoperative mRS between different age groups, χ² = 0.269, P = 0.874. Elderly complication rate was 6.0%, not significantly different from young (4.5%, P = 0.667) or senior (7.2%, P = 0.696) complication rate. Elderly LOH was 1.93 ± SD 0.176 days; not significantly different from young (3.01 ± 0.384 days, P = 0.081) or senior (2.47 ± 0.144 days, P = 0.881). Statistical equivalence testing showed with 95% confidence that there was equivalence in ΔmRS among age groups.

Conclusions: Elderly patients did not have significantly different ΔmRS, LOH, 30DRR, or complication rates after BTS compared with younger counterparts. Therefore, in healthy patients, advanced age alone should not prevent patients from being offered BTS.

Keywords: Aging; Brain tumor; Brain tumor surgery; Geriatrics; Surgical risk.