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Original research
Impact of age on 30-day postoperative outcome of surgery for ruptured and unruptured intracranial aneurysms
  1. Nima Alan1,
  2. Andreea Seicean2,
  3. Sinziana Seicean3,4,
  4. Warren R Selman5,
  5. Nicholas C Bambakidis5
  1. 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  4. 4Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Nicholas Bambakidis, Department of Neurological Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Kimberly.Duvall{at}


Objective To assess in a retrospective analysis of a prospectively collected database, the impact of increased age on 30-day postoperative outcomes of surgery for intracranial aneurysms (ICAs).

Methods 721 adult patients who underwent surgery for ICA were identified in the 2006–2012 American College of Surgeons’ National Surgical Quality Improvement Program. Baseline characteristics and 30-day outcomes were stratified by age: <50 years (n=221), 50–60 years (n=221), and >60 years (n=266). Patients <50 and 50–60 years old were propensity score-matched to those aged >60 years. Logistic regression was used to examine the relationship between increased age and surgical outcome.

Results In unadjusted analyses, age <50 years was associated with fewer postoperative complications (OR=0.5, 95% CI 0.3 to 0.7) and lower mortality (OR=0.4, 95% CI 0.2 to 0.9) compared with those aged >60 years. Patients aged between 50 and 60 years were less likely to have complications (OR=0.6, 95% CI 0.4 to 0.8) in unadjusted analyses. Upon propensity score matching, covariate balance was achieved for all age strata. In adjusted analyses, patients <50 years (OR=0.4, 95% CI 0.2 to 0.7) and 50–60 years (OR=0.5, 95% CI 0.3 to 0.8) of age continued to have fewer complications than those aged >60.

Conclusions Age >60 is independently associated with 30-day postoperative morbidity in patients undergoing surgery for ICA. The results of this study suggest age >60 should be considered an a priori risk factor in surgical management of ICA, regardless of associated comorbidities often associated with increased age.

  • Aneurysm
  • Complication
  • Hemorrhage
  • Subarachnoid

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