CRANIOTOMY FOR INTRACRANIAL ANEURYSM AND SUBARACHNOID HEMORRHAGE - ISCOURSE, COST, OR OUTCOME AFFECTED BY AGE

Background and Purpose Age may influence cost or effectiveness of trea tment for suharachnoid hemorrhage (SAW). This study examined the effec t of age on both. Methods Patients (n=219) who underwent craniotomy fo r intracranial aneurysm and SAH over 6 years at one tertiary care cent er were divided in two ways by age: single advanced age (<65 years and greater than or equal to 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 p atient included numbers of procedures and complications in the surgica l intensive care unit (SICU), number of days in the SICU and the hospi tal, costs for SICU and ward care, total cost (SICU plus ward costs), and the Acute Physiology and Chronic Health Evaluation (APACHE) II sco re at admission and discharge, the Hunt-Hess grade at admission and im mediately preoperatively, and quality of life score, a measure of outc ome. Mortality rates by age group were calculated. Results The only va riable significantly affected by decade of age was mortality rate, whi ch increased as decade of age increased (3% to 17%). With the 65-year comparison, mortality race, cost, APACHE II score at admission and dis charge, days before operation, and days in the SICU were significantly higher for age greater than or equal to 65 years. Conclusions Whereas mortality is higher fur the older age group, quality of life scores a ppear acceptable for those who survive. Even though the hospital costs of treating elderly patients for SAW may be higher than those for you nger patients, this should not be used to justify withholding care fro m the elderly.