Mortality After Trauma Craniotomy Is Decreasing in Older Adults: A Nationwide Population-Based Study

Jussi P. Posti; Teemu M. Luoto; Päivi Rautava; Ville Kytö

doi:10.1016/j.wneu.2021.05.090

Mortality After Trauma Craniotomy Is Decreasing in Older Adults: A Nationwide Population-Based Study

Jussi P. Posti^*
, Teemu M. Luoto
, Päivi Rautava
, Ville Kytö

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

12 Citations (Scopus)

96 Downloads (Pure)

Abstract

Objective: No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis and after trauma craniotomy, and later deaths for persons aged ≥60 years from 2004 to 2018. Results: The study period included 2166 patients (64% men; mean age, 70.3 years) who had undergone TBI-related craniotomy. The incidence rate of operations decreased with a concomitant decrease in adjusted mortality (30-day mortality, P < 0.001; 1-year mortality, P < 0.001) and increase in mean patient age (R² = 0.005; P < 0.001) during the study period. The cumulative mortality was 25% at 30 days and 38% at 1 year. The comorbidities increasing the hazard for 30-day mortality were diabetes, a history of malignancy, peripheral vascular disease, and a history of myocardial infarction. For 1-year mortality, the comorbidities were heart failure and a history of myocardial infarction. Evacuation of an epidural hematoma decreased the hazard for mortality. In contrast, evacuation of an intracerebral hematoma and decompressive craniectomy increased the risk at both 30 days and 1 year. Conclusions: Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.

Original language	English
Journal	World Neurosurgery
Early online date	Jun 2021
DOIs	https://doi.org/10.1016/j.wneu.2021.05.090
Publication status	Published - Aug 2021
Publication type	A1 Journal article-refereed

Funding

Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379 ), the Government’s Special Financial Transfer tied to academic research in Health Sciences , Finland (grant 11129 ), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kytö received funding from the Finnish Government’s Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation . Teemu M. Luoto has received funding from the Government’s Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere , and the Finnish Medical Society Duodecim . Päivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd. Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379), the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland (grant 11129), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kyt? received funding from the Finnish Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation. Teemu M. Luoto has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere, and the Finnish Medical Society Duodecim. P?ivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Craniotomy
Elderly patients
Mortality
Outcome
Traumatic brain injury

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Surgery
Clinical Neurology

Access to Document

10.1016/j.wneu.2021.05.090Licence: CC BY

1-s2.0-S1878875021007853-main-1Final published version, 493 KBLicence: CC BY

http://urn.fi/URN:NBN:fi:tuni-202106306143Licence: CC BY

Cite this

@article{da180573f3e04bcd9c26f990d3dea713,

title = "Mortality After Trauma Craniotomy Is Decreasing in Older Adults: A Nationwide Population-Based Study",

abstract = "Objective: No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis and after trauma craniotomy, and later deaths for persons aged ≥60 years from 2004 to 2018. Results: The study period included 2166 patients (64\% men; mean age, 70.3 years) who had undergone TBI-related craniotomy. The incidence rate of operations decreased with a concomitant decrease in adjusted mortality (30-day mortality, P < 0.001; 1-year mortality, P < 0.001) and increase in mean patient age (R2 = 0.005; P < 0.001) during the study period. The cumulative mortality was 25\% at 30 days and 38\% at 1 year. The comorbidities increasing the hazard for 30-day mortality were diabetes, a history of malignancy, peripheral vascular disease, and a history of myocardial infarction. For 1-year mortality, the comorbidities were heart failure and a history of myocardial infarction. Evacuation of an epidural hematoma decreased the hazard for mortality. In contrast, evacuation of an intracerebral hematoma and decompressive craniectomy increased the risk at both 30 days and 1 year. Conclusions: Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.",

keywords = "Craniotomy, Elderly patients, Mortality, Outcome, Traumatic brain injury",

author = "Posti, \{Jussi P.\} and Luoto, \{Teemu M.\} and P{\"a}ivi Rautava and Ville Kyt{\"o}",

note = "Funding Information: Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379 ), the Government{\textquoteright}s Special Financial Transfer tied to academic research in Health Sciences , Finland (grant 11129 ), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kyt{\"o} received funding from the Finnish Government{\textquoteright}s Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation . Teemu M. Luoto has received funding from the Government{\textquoteright}s Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere , and the Finnish Medical Society Duodecim . P{\"a}ivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd. Funding Information: Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379), the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland (grant 11129), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kyt? received funding from the Finnish Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation. Teemu M. Luoto has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere, and the Finnish Medical Society Duodecim. P?ivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd. Publisher Copyright: {\textcopyright} 2021 The Author(s)",

year = "2021",

month = aug,

doi = "10.1016/j.wneu.2021.05.090",

language = "English",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier",

}

TY - JOUR

T1 - Mortality After Trauma Craniotomy Is Decreasing in Older Adults

T2 - A Nationwide Population-Based Study

AU - Posti, Jussi P.

AU - Luoto, Teemu M.

AU - Rautava, Päivi

AU - Kytö, Ville

N1 - Funding Information: Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379 ), the Government’s Special Financial Transfer tied to academic research in Health Sciences , Finland (grant 11129 ), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kytö received funding from the Finnish Government’s Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation . Teemu M. Luoto has received funding from the Government’s Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere , and the Finnish Medical Society Duodecim . Päivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd. Funding Information: Conflict of interest statement: Jussi P. Posti has received funding from the Academy of Finland (grant 17379), the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland (grant 11129), and the Maire Taponen Foundation and has received speaker's fees from Finnish Medical Association. Ville Kyt? received funding from the Finnish Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and a grant from Finnish Cultural Foundation and Paulo Foundation. Teemu M. Luoto has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences, Finland and research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere, and the Finnish Medical Society Duodecim. P?ivi Rautava has received speaker's fees from Pharmaceutical Information Centre Ltd. Publisher Copyright: © 2021 The Author(s)

PY - 2021/8

Y1 - 2021/8

N2 - Objective: No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis and after trauma craniotomy, and later deaths for persons aged ≥60 years from 2004 to 2018. Results: The study period included 2166 patients (64% men; mean age, 70.3 years) who had undergone TBI-related craniotomy. The incidence rate of operations decreased with a concomitant decrease in adjusted mortality (30-day mortality, P < 0.001; 1-year mortality, P < 0.001) and increase in mean patient age (R2 = 0.005; P < 0.001) during the study period. The cumulative mortality was 25% at 30 days and 38% at 1 year. The comorbidities increasing the hazard for 30-day mortality were diabetes, a history of malignancy, peripheral vascular disease, and a history of myocardial infarction. For 1-year mortality, the comorbidities were heart failure and a history of myocardial infarction. Evacuation of an epidural hematoma decreased the hazard for mortality. In contrast, evacuation of an intracerebral hematoma and decompressive craniectomy increased the risk at both 30 days and 1 year. Conclusions: Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.

AB - Objective: No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis and after trauma craniotomy, and later deaths for persons aged ≥60 years from 2004 to 2018. Results: The study period included 2166 patients (64% men; mean age, 70.3 years) who had undergone TBI-related craniotomy. The incidence rate of operations decreased with a concomitant decrease in adjusted mortality (30-day mortality, P < 0.001; 1-year mortality, P < 0.001) and increase in mean patient age (R2 = 0.005; P < 0.001) during the study period. The cumulative mortality was 25% at 30 days and 38% at 1 year. The comorbidities increasing the hazard for 30-day mortality were diabetes, a history of malignancy, peripheral vascular disease, and a history of myocardial infarction. For 1-year mortality, the comorbidities were heart failure and a history of myocardial infarction. Evacuation of an epidural hematoma decreased the hazard for mortality. In contrast, evacuation of an intracerebral hematoma and decompressive craniectomy increased the risk at both 30 days and 1 year. Conclusions: Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.

KW - Craniotomy

KW - Elderly patients

KW - Mortality

KW - Outcome

KW - Traumatic brain injury

U2 - 10.1016/j.wneu.2021.05.090

DO - 10.1016/j.wneu.2021.05.090

M3 - Article

C2 - 34082165

AN - SCOPUS:85107776993

SN - 1878-8750

JO - World Neurosurgery

JF - World Neurosurgery

ER -

Mortality After Trauma Craniotomy Is Decreasing in Older Adults: A Nationwide Population-Based Study

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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