Effect of age variability on clinical outcome of patients undergoing awake craniotomy

Abstract Background The literature on the age variability and its effect on clinical outcome of patients undergoing awake craniotomy (AC) procedure is lacking. We aimed to compare the varied age groups as defined by the World Health Organization (WHO) with the clinical outcome of patients undergoing AC. Methods Retrospective data of patients who underwent AC from January 1, 2016, to August 1, 2024, were collected. Data pertaining to pre-anesthetic evaluation, intraoperative management and postoperative course were collected. The primary outcomes of our study were length of stay in intensive care unit (ICU) and hospital. Results A total of 127 patients underwent AC procedure during the study period. The patients included children (N = 12; 9%), youth (N = 19; 15%), young (N = 76; 60%), middle age (N = 15; 12%) and old (N = 5; 4%). The old age group had a longer length of stay in the ICU (2 ± 2.61 days; p = 0.01). Intraoperative conversion to GA was found to have a negative association with ICU length of stay in young patients (coefficient − 1.18 [− 1.91 to − 0.46], p = 0.002). The length of stay in the hospital was comparable across age groups (p = 0.35). Conclusion Awake craniotomy is safe and feasible across age groups, though subgroup findings, especially in the elderly, should be interpreted with caution. In young adults, intraoperative conversion to GA associated with shorter ICU stay may reflect underlying confounding factors rather than a true beneficial effect.