Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/35748
Title: | Influence of comorbidities on treatment of unruptured intracranial aneurysms in the elderly. | Authors: | Chandra R.V.;O'Neill A.H.;Xenos C.;Danks A.R.;Chong W.;Lai L.T. ;Slater L.-A. | Institution: | (O'Neill, Xenos, Danks, Lai) Department of Neurosurgery, Monash Health, Melbourne, Australia (Chandra, Danks, Lai) Department of Surgery, Monash University, Melbourne, Australia (Chandra, Slater, Chong) Neuro-Interventional Radiology Unit, Department of Imaging, Monash Health, Melbourne, Australia | Issue Date: | 20-Mar-2019 | Copyright year: | 2019 | Publisher: | Churchill Livingstone | Place of publication: | United Kingdom | Publication information: | Journal of Clinical Neuroscience. 62 (pp 38-45), 2019. Date of Publication: April 2019. | Journal: | Journal of Clinical Neuroscience | Abstract: | Current evidence does not conclusively justify conservative management of unruptured intracranial aneurysms (UIA) in the elderly (age >= 65 years). To rationalise intervention, the authors investigated the role of age and comorbidity burden on treatment outcomes. A retrospective chart review for consecutive cases of UIAs treated in the elderly between 2007 and 2018 was performed. Preoperative Charlson Comorbidity Index (CCI) and Neurovascular Comorbidities Index (NCI) were calculated. Standard statistical methods with univariate and multiple logistic regression were used. A total of 123 patients (46 surgery, 77 endovascular) with 131 UIAs were treated. The mean age was 70.6 +/- 4.1 years, and 90 patients were female (73.1%). The mean aneurysm size was 8.6 +/- 5.0 mm, and the mean follow up period was 22.9 +/- 21.3 months. The rates of poor outcome (mRS > 1) at discharge, 6 weeks and 6 months were 9.8%, 5.8% and 3.6%, respectively. There was no difference in outcomes between surgical and endovascular treatment. Correlation and regression analyses revealed that aneurysm size, higher preoperative comorbidity index (CCI > 4), and endovascular treatment with a stent or flow diverter (p = 0.009, 0.02, and 0.005, respectively) were associated with a poor outcome. When adjusted in a multivariate analysis, only high comorbidity burden (CCI > 4) predicted unfavourable outcome (p = 0.01). Elderly patients who undergo treatment for UIAs are at high risk of postoperative deterioration. Careful preoperative case selection based on comorbidity burden, rather than chronological age, would be useful for improved risk stratification.Copyright © 2019 Elsevier Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.jocn.2019.01.013 | PubMed URL: | 30655235 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30655235] | ISSN: | 0967-5868 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35748 | Type: | Article | Subjects: | heart arrhythmia/co [Complication] hematoma/co [Complication] human hyponatremia/co [Complication] lung embolism/co [Complication] major clinical study mortality outcome assessment pneumonia/co [Complication] priority journal retrospective study risk assessment risk factor seizure/co [Complication] sepsis/co [Complication] subdural hematoma/co [Complication] treatment outcome *unruptured intracranial aneurysm/di [Diagnosis] *unruptured intracranial aneurysm/su [Surgery] *unruptured intracranial aneurysm/th [Therapy] very elderly flow diverter Neurovascular Comorbidities Index male acute kidney failure/co [Complication] aged aneurysm clipping aneurysm size article brain hemorrhage/co [Complication] Charlson Comorbidity Index clinical feature cohort analysis coil embolization *comorbidity comorbidity assessment deep vein thrombosis/co [Complication] delirium/co [Complication] deterioration disease burden endovascular aneurysm repair female follow up *comorbidity comorbidity assessment deep vein thrombosis / complication delirium / complication deterioration disease burden endovascular aneurysm repair female follow up heart arrhythmia / complication hematoma / complication human hyponatremia / complication lung embolism / complication major clinical study male mortality outcome assessment pneumonia / complication priority journal retrospective study risk assessment risk factor aged sepsis / complication subdural hematoma / complication treatment outcome *unruptured intracranial aneurysm / *diagnosis / *surgery / *therapy very elderly acute kidney failure / complication seizure / complication aneurysm clipping aneurysm size Article brain hemorrhage / complication Charlson Comorbidity Index clinical feature cohort analysis coil embolization |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.