Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older

IMPORTANCE The use of skull base surgery in patients 70 years or older is increasing, but its safety in this age group has not been evaluated to date. OBJECTIVES To describe outcomes in a cohort of patients 70 years or older undergoing skull base surgery and to evaluate whether age, type of disease process, and approach (endoscopic vs traditional open surgery) are associated with increased intraoperative and postoperative complications in this population. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed a population-based sample of 219 patients 70 years or older from a database of 1720 patients who underwent skull base surgery at University of North Carolina Hospitals, Chapel Hill, a tertiary referral center, between October 2007 and June 2017. Data were collected from June 2016 to July 2017 and analyzed in July 2017 and August 2017. EXPOSURE Skull base surgery. MAIN OUTCOMES AND MEASURES Data collected included demographic characteristics, surgical approach, and disease process. Intraoperative findings and postoperative complications were analyzed by age, surgical approach, and malignancy status. RESULTS Of the 219 patients, 166 were aged 70.0 to 79.9 years and 53 patients were older than 80 years (mean [SD] age, 76.4 [4.7] years); 120 (54.8%) were men and 160 (73.7%) were white. There were 161(73.5%) endoscopic and 58 (26.5%) open operations. The most common pathologic processes amongthe 219 patients were nonsellar malignant (81 [37.0%]). nonsellar benign (53 [24.2%]), and pituitary (49 [22.4%]) tumors. The most common intraoperative and postoperative complications were intraoperative major bleeding (5 of 219 patients [2.3%]) and postoperative bleeding (9 [4.1%]). Thirty-day mortality was zero. There was no clinically meaningful difference in complications between patients aged 70.0 to 79.9 years vs those older than 80 years, endoscopic vs open surgery, or benign vs malignant neoplasms. Specifically, between the endoscopic and open surgery groups, there was no difference in intraoperative major bleeding (3.9%; 95% CI, -0.7% to 12.9%), postoperative cerebrospinal fluid leak ( 0.6%; 95% CI, -3.4% to 5.6%), or postoperative bleeding (1.5%; 95% CI, 3.9% to 10.6%). CONCLUSIONS AND RELEVANCE Skull base surgery is a safe option in persons 70 years or older, with similar outcomes across age ranges, surgical approaches, and disease processes.