Skull Base Complications and 30-Day Readmission: An Evaluation of the Elderly from the National Surgical Quality Improvement Program (NSQIP) Database

Objective: Older patient age is associated with worse outcomes and higher complication rates in a variety of neurosurgical diseases. Whether age has a similar impact on patient outcome after skull base procedures has not been demonstrated.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to evaluate patients who underwent anterior, lateral, and posterior fossa skull base procedures between 2005 and 2018.

Results: A total of 17,980 patients from 2005 to 2018 were categorized by age into the following groups: <65 (n = 13,132) or ≥65 years (n = 4,848). Complications occurred at a significantly higher rate in older patients (14 vs. 21%, p = 0.0001), especially among anterior skull base, cerebellopontine angle, and craniopharyngioma cases. The 30-day unplanned readmission rate was also higher for older patients (9 vs. 11%, p = 0.0001) along with higher likelihood of disposition to skilled nursing facilities (2.4 vs. 8.4%) or rehabilitation (7 vs. 12.6%). Trends over time showed improvement in outcomes after skull base procedures to a lesser extent in the elderly. Age was independently associated with a higher risk of complications and 30-day readmission in multivariate analysis.

Conclusion: Our results indicate that elderly patients undergoing skull base surgical procedures have worse outcomes and higher likelihood of readmission, in spite of adjusting for various medical comorbidities and frailty. The impact of age on outcome after skull base surgery also varies by surgical site and type. Greater attention to older patients and closer perioperative management may be helpful for improving outcomes.

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Artikel online veröffentlicht:
12. Februar 2021