Are Octogenarians at Higher Risk of Complications After Elective Lumbar Spinal Fusion Surgery?

Analysis of a Cohort of 7880 Patients From the Kaiser Permanente Spine Registry

Calvin C. Kuo, MD; Kathryn E. Royse, PhD, MPH, MSPH; Heather A. Prentice, PhD, MPH; Jessica E. Harris, MS, RD; Kern H. Guppy, MD, PhD

Disclosures

Spine. 2022;47(24):1719-1727. 

In This Article

Abstract and Introduction

Abstract

Study Design: A retrospective cohort study with chart review.

Objective: To determine if there is a difference in risk of adverse outcomes following elective posterior instrumented lumbar spinal fusions for patients aged 80 years and above compared with patients aged 50 to 79 years.

Summary of Background Data: Patients aged 80 years and above are undergoing elective lumbar spinal fusion surgery in increasing numbers. There are conflicting data on the risks of intraoperative and postoperative complications in these patients.

Materials and Methods: Patients aged 80 years and above were compared with 50 to 79 years (reference group) using time-dependent multivariable Cox proportional hazards regression with a competing risk of death for longitudinal outcomes and multivariable logistic regression for binary outcomes. Outcome measures used were: (1) intraoperative complications (durotomy), (2) postoperative complications: 30-day outcomes (pneumonia); 90-day outcomes (deep vein thrombosis, pulmonary embolism, emergency room visits, readmission, reoperations, and mortality); and two-year outcomes (reoperations and mortality).

Results: The cohort consisted of 7880 patients who underwent primary elective posterior instrumented lumbar spinal fusion (L1–S1) for degenerative disk disease or spondylolisthesis. This was subdivided into 596 patients were aged 80 years and above and 7284 patients aged 50 to 79. After adjustment, patients aged 80 years and above had a higher likelihood of durotomy [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.02–2.02] and 30-day pneumonia (OR=1.81, 95% CI = 1.01–3.23). However, there was a lower risk of reoperation within two years of the index procedure (hazard ratio = 0.69, 95% CI = 0.48–0.99). No differences were observed for mortality, readmissions, emergency room visits, pulmonary embolism, or deep vein thrombosis.

Conclusions: In a cohort of 7880 elective posterior instrumented lumbar fusion patients for degenerative disk disease or spondylolisthesis, we did not observe any significant risks of adverse events between patients aged 80 years and above and those aged 50 to 79 except for higher durotomies and 30-day pneumonia in the former. We believe octogenarians can safely undergo lumbar fusions, but proper preoperative screening is necessary to reduce the risks of 30-day pneumonia.

Introduction

The global population aged 80 and older is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million.[1] As the population ages, the incidence of degenerative disease of the spine also increases, resulting in a concomitant increase in the number of elective spinal surgeries being performed.[2] While it has been historically accepted that elderly patients undergoing spine procedures may not do as well as younger patients, there may be variation risks depending on the type of spine procedure performed and how recently it was done.[3] Carreon et al,[4] in 2003, found that patients over the age of 75 treated with lumbar decompression and fusions had a 49% major complication rate, three times that of patients 65 to 74 years old. Still, the benefits may outweigh the risks for some given patients may desire not only longevity but to the ability to thrive throughout their ninth and 10th decades of life.

Prior studies have reported conflicting outcomes in octogenarians undergoing lumbar surgery.[3–7] Several of these are limited by smaller sample sizes (<50 patients),[5,7–9] heterogeneity of type of surgery (mixture of instrumented, noninstrumented fusions, and laminectomies only),[4,5,10–12] and no comparison to younger age groups.[4–6,9,11–14] In our study, we present one of the largest cohorts of posterior instrumented lumbar fusion procedures to evaluate the risk of intraoperative and postoperative outcomes for patients aged 50 to 79 years old compared with patients aged 80 years old and above.

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