Neurocirugía en el paciente mayor: neurocirugía geriátrica

González-Bonet, Luis Germán; Tarazona-Santabalbina, Francisco José; Tudela, Luís Lizán

doi:10.1016/j.neucir.2015.11.003

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…For each aging person there are a personal rate of degeneration of CNS as like as the whole body, in anatomy, in mental and physical activity, also in higher costs of living, lifestyle change, loneliness, possible dependence of specific medication for medical associated illnesses -such as diabetes and cardiovascular disease (3)(6). It's also a reality that the elderly population represent the fastest growing segment of the world's population; the world's population over 60 years will double between 2000 and 2050 and the number of people aged 80 and older will quadruple (7). 47,8 million the number of people age 65 and older in the United States on July 1,2015; this group accounted for 14,9 per cent of the total population (15).…”

Section: Discussionmentioning

confidence: 99%

“…The number of elderly patients is increasing worldwide, generating a larger concern (3)(4)(5)(6)(7), an increasing problem regarding socio-economic reasons related to the medical act, morbidity and additional care requirements, perioperative adverse events (8)(9)(10). It is estimated that between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple (7) (11). For neurosurgical patient, beyond the age of 65 years, both chronic or in emergency, all measures should be institute to maintain quality of life, to avoid perioperative mortality and morbidity (10).…”

Section: Introductionmentioning

confidence: 99%

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Neurosurgery in the elderly patient

Iacob¹

2019

roneuro

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Objective. For government officials and health providers, elderly population - aged 65 and over, especially neurosurgical patient, represent a larger concern, an increasing problem not only for socio-economic reasons related to the medical act, but also for additional care requirements which should be done by the family and society, including rehabilitation facilities, occupational & physical therapy, speech therapists, visiting nurses, to insure an effective recuperation after hospital discharge. A retrospective study with 325 "elderly" patients cohort, aged 65 and over, admitted in the Neurosurgery Department undergoing common neurosurgical procedures, in the last five years offer an evaluation for neurosurgical procedures, outcomes, comorbidities, anaesthetic and analgesic requirements, outcome. Material and method. This study was performed on patients aged 65 years or older, with neurosurgical diseases, admitted to the Neurosurgery or the Intensive Care Unit of our hospital, between 2014-2019. An analysis was made on variables such as age, pathology, comorbidities, length of hospital stay especially in the ICU unit, type of cranio-cerebral or spinal procedures performed, anaesthesia protocols, complications, performance status, re-admissions and mortality. Results. Patients age were divided into three categories: between 65-70 years old there were 152 patients (46,76%), between 70-85 years old 93 patients (28.61%) and over 85 years old 80 patients (24,61%). 173 patients were females (53,23%), 152 were males (46.76 %). The admission Glasgow Coma Scale (GCS) score to those over 85 years old was between 3-12 in 29 cases (8.02%) with early death in 13 patients. Several comorbidities were noticed in 294 patients (90.15%): cardiac, pulmonary, hematologic especially coumarinic overdose, hepatic and renal failures, psychiatric illnesses, concomitant systemic disease or immunosuppressed patients by decompensated diabetes, primitive cancers affecting various organs, infectious diseases, also severe osteoporosis, chronic ethylic intoxication, limiting surgical attitude, also obtaining the informed consent for surgery. There were 154 (47,38%) patients with cerebral pathology and 171 (52,61%) patients with spinal pathology. Most common surgical procedures performed were: craniotomies for tumours and hematoma removal, minimal invasive procedures for spine, endovascular and vertebroplasty. The median length of stay for emergency patients was significantly longer than that of elective patients (13 vs. 8 days). For 215 (66.15%) patients general anaesthesia was performed, local anaesthesia in 97 (29.84%) patients, 13 patients (4%) were not operated. Good quality of life results appreciated by patients and relatives were recorded in 236 cases (72.61%) in the first and second category; less better results to those over 85 years old; same symptoms especially pain 63 patients (19.38%), complications to 47 patients (14,46%) especially cardiac, renal and respiratory failures, also motor deficits, seizures, CSF fistula, mortality in 26 cases (8%), re-admissions in 45 cases (13.84%) less than 1 month after discharge. Conclusions. Old prejudices that old age is a contraindication for surgery have to be removed. Clinical and surgical decisions for neurosurgical procedures in the elderly are decisive for limiting reported morbidity and mortality rates. For life quality, realistic family and society expectations, several aspects should be considered for safe and effective results: careful patient selection on patient status, comorbidities and physiological reserve; neurosurgical pathology, urgency of the surgical procedure, the strategy of neurosurgical management based on advances in imaging and interventional radiology, minimal invasive neurosurgical procedures with significant preoperative and postoperative care. Good results could be obtained even in elderly people for chronic subdural hematoma, simple brain or spinal tumour, good grade aneurysm, trigeminal pain, vertebroplasty in spinal vertebral fractures, etc.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurosurgery in the elderly patient

Iacob¹

2019

roneuro

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“…Multimorbid patients are commonplace in the neurosurgical intensive care unit (ICU), as a consequence of prolonged life expectancy with rise in the prevalence of chronic diseases [ 1 , 2 ]. Comorbidities decrease physiological reserve, thereby increasing the risk of progressive organ failure in instances of physiologic stress, such as hypoxemia, extreme changes in blood pressure, hypovolemia, acute blood losses and conditions of heightened sympathetic activity.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

Algahtani

Merenda

2020

Neurocrit Care

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With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient's deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra-and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.

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Geriatric neurosurgery in a suburban community: A preliminary review of a single neurosurgeon experience

Okunlola

Babalola

et al. 2021

Interdisciplinary Neurosurgery

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Neurocirugía en el paciente mayor: neurocirugía geriátrica

Cited by 5 publications

References 37 publications

Neurosurgery in the elderly patient

Neurosurgery in the elderly patient

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

Geriatric neurosurgery in a suburban community: A preliminary review of a single neurosurgeon experience

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