Acta Neurochirurgica

, Volume 159, Issue 3, pp 517–525 | Cite as

National trends following decompression, discectomy, and fusion in octogenarians and nonagenarians

  • Doniel Drazin
  • Carlito Lagman
  • Siddharth Bhargava
  • Miriam Nuño
  • Terrence T. Kim
  • J. Patrick Johnson
Original Article - Spine

Abstract

Background

The National Inpatient Sample (NIS) database is used to evaluate a wide variety of surgical procedures across a range of specialties. The authors of this study assess national trends of the three commonest spine procedures performed (decompression, fusion, and discectomy) in patients between the ages of 80 and 100 years (octogenarians and nonagenarians).

Methods

The NIS database was queried to identify patients between the ages of 80 and 100 with a primary diagnosis of spinal stenosis, disk herniation without myelopathy, or protrusion due to degeneration of spine/disk disorders and who have undergone spinal decompression, fusion, or discectomy between the years 1998 and 2011. Variables of concern included length-of-stay (LOS), non-routine discharge, average total charges, in-hospital complications, and mortality rate.

Results

Decompression was the most common procedure performed (n = 113,267, 50.5%). Fusion (n = 60,345, 26.9%) was associated with the longest LOS (5.1 days), highest in-hospital complication and mortality rates (n = 13,170, 21.8% and n = 449, 0.7%, respectively), most non-routine discharges (n = 42,662, 70.7%), and highest mean for average total charges ($69,295) (p < 0.001). Discectomy (n = 50,740, 22.6%), had the shortest LOS (3.7 days), lowest complication and mortality rates (n = 6823, 13.4% and n = 102, 0.2%, respectively), fewest non-routine discharges (n = 22,861, 45.1%), and lowest mean for average total charges ($22,787) (p < 0.001).

Conclusions

Decompression was most common. Fusion had the longest LOS, highest complication and mortality rates, most non-routine discharges, and was most expensive. Discectomy was least commonly performed, had the shortest LOS, lowest complication and mortality rates, fewest non-routine discharges, and was least expensive.

Keywords

Aged 80 and over Decompression Discectomy Spinal fusion 

References

  1. 1.
    Bae HW, Rajaee SS, Kanim LE (2013) Nationwide trends in the surgical management of lumbar spinal stenosis. Spine 38:916–926CrossRefPubMedGoogle Scholar
  2. 2.
    Best MJ, Buller LT, Eismont FJ (2015) National trends in ambulatory surgery for intervertebral disc disorders and spinal stenosis: a 12-year analysis of the national surveys of ambulatory surgery. Spine 40:1703–1711Google Scholar
  3. 3.
    Boakye M, Patil CG, Santarelli J, Ho C, Tian W, Lad SP (2008) Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery 62:455–461, discussion 461–452CrossRefPubMedGoogle Scholar
  4. 4.
    Boakye M, Patil CG, Santarelli J, Ho C, Tian W, Lad SP (2008) Laminectomy and fusion after spinal cord injury: national inpatient complications and outcomes. J Neurotrauma 25:173–183CrossRefPubMedGoogle Scholar
  5. 5.
    Farjoodi P, Skolasky RL, Riley LH (2011) The effects of hospital and surgeon volume on postoperative complications after lumbar spine surgery. Spine (Phila Pa 1976) 36:2069–2075CrossRefGoogle Scholar
  6. 6.
    Kalakoti P, Missios S, Maiti T, Konar S, Bir S, Bollam P, Nanda A (2016) Inpatient outcomes and postoperative complications after primary versus revision lumbar spinal fusion surgeries for degenerative lumbar disc disease: a national (nationwide) inpatient sample analysis, 2002–2011. World Neurosurg 85:114–124CrossRefPubMedGoogle Scholar
  7. 7.
    Khashan M, Lidar Z, Salame K, Mangel L, Lador R, Drexler M, Sapirstein E, Regev GJ (2016) Minimally invasive spinal decompression in patients older than 75 years of age: perioperative risks, complications, and clinical outcomes compared with patients younger than 45 years of age. World Neurosurg 337–342Google Scholar
  8. 8.
    Lukasiewicz AM, Bohl DD, Varthi AG, Basques BA, Webb ML, Samuel AM, Grauer JN (2016) Spinal fracture in patients with ankylosing spondylitis: cohort definition, distribution of injuries, and hospital outcomes. Spine (Phila Pa 1976) 41:191–196CrossRefGoogle Scholar
  9. 9.
    Ma Y, Passias P, Gaber-Baylis LK, Girardi FP, Memtsoudis SG (2010) Comparative in-hospital morbidity and mortality after revision versus primary thoracic and lumbar spine fusion. Spine J 10:881–889CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Memtsoudis SG, Kirksey M, Ma Y, Chiu YL, Mazumdar M, Pumberger M, Girardi FP (2012) Metabolic syndrome and lumbar spine fusion surgery: epidemiology and perioperative outcomes. Spine (Phila Pa 1976) 37:989–995CrossRefGoogle Scholar
  11. 11.
    Memtsoudis SG, Vougioukas VI, Ma Y, Gaber-Baylis LK, Girardi FP (2011) Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery. Spine (Phila Pa 1976) 36:1867–1877CrossRefGoogle Scholar
  12. 12.
    Ney JP, van der Goes DN, Nuwer MR (2015) Does intraoperative neurophysiologic monitoring matter in noncomplex spine surgeries? Neurology 85:2151–2158CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pastor PN, Makuc DM, Reuben C, Xia H (2002) In: National Center for Health Statistics. Chartbook on trends in the health of Americans. Health, United StatesGoogle Scholar
  14. 14.
    Paul JC, Lonner BS, Goz V, Weinreb J, Karia R, Toombs CS, Errico TJ (2015) Complication rates are reduced for revision adult spine deformity surgery among high-volume hospitals and surgeons. Spine J 15:1963–1972CrossRefPubMedGoogle Scholar
  15. 15.
    Pumberger MCY, Ma Y, Girardi FP, Mazumdar M, Memtsoudis SG (2012) National in-hospital morbidity and mortality trends after lumbar fusion surgery between 1998 and 2008. J Bone Joint Surg Br 94:359–364CrossRefPubMedGoogle Scholar
  16. 16.
    Pumberger MCY, Ma Y, Girardi FP, Vougioukas V, Memtsoudis SG (2012) Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors. Eur Spine J 21:1633–1639CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Savage JW, Anderson PA (2015) In: Browner BD, Jupiter JB, Krettek C, Anderson P (eds). Skeletal trauma: basic science, management, and reconstruction, 5th edn. Elsevier Saunders, PhiladelphiaGoogle Scholar
  18. 18.
    Szpalski M, Gunzburg R (2003) Lumbar spinal stenosis in the elderly: an overview. Eur Spine J 12(Suppl 2):S170–S175CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Vincent GK, Velkoff VA (2010) In: U.S. Census Bureau. The next four decades the older population in the United States: 2010 to 2050. Population estimates and projections. U.S. Dept. of Commerce, Economics and Statistics Administration, U.S. Census Bureau, Washington, DC, pp 25–1138Google Scholar
  20. 20.
    West LACS, Goodkind D, He W (2014) In: Bureau USC (ed) 65+ in United States: 2010. U.S. Government Printing Office, Washington, DC, pp P23–P212Google Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Doniel Drazin
    • 1
  • Carlito Lagman
    • 1
  • Siddharth Bhargava
    • 1
  • Miriam Nuño
    • 1
  • Terrence T. Kim
    • 2
  • J. Patrick Johnson
    • 1
  1. 1.Department of NeurosurgeryCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of Orthopedic SurgeryCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations