Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study
- 34 Downloads
To compare peri-operative complication rates in ≥ 85-year-old patients who underwent decompression surgery with or without instrumented fusion for degenerative disorders.
This study involved 907 patients who underwent lumbar spine surgery for degenerative disorders between January 2006 and June 2012. Of these, 33 patients (3.6% of the entire population) were over 85 years of age (85–94 years). Decompression-alone and instrumentation groups were compared in terms of comorbidities, American Society of Anesthesiologists (ASA)-physical status (PS) class, peri-operative complications, and Japanese Orthopedic Association (JOA) scores.
Thirty-three ≥ 85-year-old patients underwent surgery. All were ASA-PS class 2 (94%) or 3. The decompression-alone (n = 19) and instrumentation (n = 14) groups did not differ in comorbidity (95 vs. 100%, P = 0.383) or ASA-PS class (P = 0.561). Both exhibited improved JOA scores (decompression-alone: 13.4/29 to 22.7/29; instrumentation: 8.6/29 to 17.9/29; P = 0.9068) and had similar peri-operative complication rates (21.0 vs. 28.5%, P = 0.374).
Although instrumentation is considered more invasive than decompression, we detected no statistically significant differences in peri-operative complication rates between these two types of surgery in ≥ 85-year-old patients. Surgeons should perform instrumentation even in the patients over 85 years with ASA class 3 or less.
KeywordsPerioperative complications Decompression Instrumentation surgery Elderly old patients Comorbidities ASA-PS classification
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
The study was approved by the clinical ethics committee of the Spine Center in XXXX Central General Hospital (approval number: 2017-4) and was conducted according to the 1964 Helsinki Declaration and its later amendments. All participants gave written informed consent.
- 1.organaization Wh (2016) Multisectoral action for a life course approach to healthy ageing: draft global strategy and plan of action on ageing and health. SIXTY-NINTH WORLD HEALTH ASSEMBLY A69/17Google Scholar
- 4.Nagashima H, Dokai T, Hashiguchi H, Ishii H, Kameyama Y, Katae Y, Morio Y, Morishita T, Murata M, Nanjo Y, Takahashi T, Tanida A, Tanishima S, Yamane K, Teshima R (2011) Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 20(2):240–246. https://doi.org/10.1007/s00586-010-1672-7 CrossRefGoogle Scholar
- 5.Izumida SI,S (1986) Assessment of treatment for low back pain. J Jpn Orthop Assoc 60:391–394Google Scholar
- 7.Yadla S, Malone J, Campbell PG, Maltenfort MG, Harrop JS, Sharan AD, Vaccaro AR, Ratliff JK (2010) Obesity and spine surgery: reassessment based on a prospective evaluation of perioperative complications in elective degenerative thoracolumbar procedures. Spine J: Off J North Am Spine Soc 10(7):581–587. https://doi.org/10.1016/j.spinee.2010.03.001 CrossRefGoogle Scholar
- 9.Fu KM, Smith JS, Polly DW Jr, Ames CP, Berven SH, Perra JH, McCarthy RE, Knapp DR Jr, Shaffrey CI, Scoliosis Research Society M, Mortality C (2011) Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurg Spine 14(4):470–474. https://doi.org/10.3171/2010.12.SPINE10486 CrossRefPubMedGoogle Scholar
- 11.Task Force for Preoperative Cardiac Risk A, Perioperative Cardiac Management in Non-cardiac S, European Society of C, Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Van den Berghe G, Vermassen F (2009) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 30 (22):2769–2812. doi: https://doi.org/10.1093/eurheartj/ehp337