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Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

  • Neuro-Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

Risks of brain surgery in elderly patients with brain metastases are not well defined. This study was designed to quantify the postoperative risk for these patients after brain surgery for metastatic disease to the brain.

Methods

We performed a retrospective analysis of the Nationwide Inpatient Sample (1998–2005). Patients aged 65 years or older who underwent tumor resection of brain metastases were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included systemic postoperative complications, length of stay (LOS), and total charges.

Results

A total of 4,907 patients (53.6% men) were identified. Mean age was 72.1 years. Mean Charlson comorbidity score was 7.8. Inpatient mortality was 4%. The most common adverse events were pulmonary complications (3.4%). Mean length of stay was 9.2 days. Mean total charges were $57,596.39.

In multivariate analysis, patients up to age 80 years had no significantly greater odds of inpatient death, relative to their 65- to 69-year-old counterparts. Each 1-point increase in Charlson score was associated with 12% increased odds of death, 0.52 days increased LOS, and $1,710.61 higher hospital charges. Postoperative pulmonary complications, stroke, or thromboembolic events increased LOS and total charges by up to 9.6 days and $57,664.42, respectively. These associations were statistically significant (P < 0.05).

Conclusions

Surgical resection of brain metastases among the elderly up to the ninth decade of life is feasible. Age older than 80 years and higher Charlson comorbidity scores were found to be important prognostic factors for inpatient outcome. Incorporating these factors into preoperative decision making may help to select appropriately those elderly candidates for neurosurgical intervention.

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Acknowledgment

This work was supported in part by grants from American Physicians Fellowship (APF) (Grossman), Johns Hopkins Center for Innovative Medicine (Mukherjee), and the Department of Neurosurgery (Brem, Quiñones-Hinojosa), and Surgery (Chang) at Johns Hopkins University School of Medicine.

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The authors have nothing to disclose.

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Authors and Affiliations

  1. Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Rachel Grossman MD, Debraj Mukherjee MD, David C. Chang PhD, Michael Purtell MD, Michael Lim MD, Henry Brem MD & Alfredo Quiñones-Hinojosa MD

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  1. Rachel Grossman MD
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  2. Debraj Mukherjee MD
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Corresponding author

Correspondence to Alfredo Quiñones-Hinojosa MD.

Additional information

R. Grossman and D. Mukherjee are contributed equally to this study.

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Grossman, R., Mukherjee, D., Chang, D.C. et al. Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors. Ann Surg Oncol 18, 521–528 (2011). https://doi.org/10.1245/s10434-010-1299-2

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  • DOI: https://doi.org/10.1245/s10434-010-1299-2

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