Spine surgeons from 7 institutions in Sapporo, Hokkaido, Japan, conducted a multicenter, prospective study of spine surgeries performed in patients age 80 and older, and found that although the overall perioperative complication rate was high at 20%, no major systemic complications and no deaths were reported. They concluded that spine surgery is safe in this age group.
The study was published today in the Journal of Neurosurgery: Spine.
The authors conducted the prospective multicenter study with 2 goals:
- Determine if any perioperative complications of spine surgery are associated with older age (80 and older)
- Investigate the risk factors for perioperative systemic complications in this age group
The board-certified spine surgeons who participated in the study evaluated data on 270 patients age 80 and older who underwent elective spine surgery in 2017. Patients with tumors, infection, or trauma were not included.
Perioperative complications were defined as adverse events occurring during surgery or within 30 days postoperatively. Complications were separated into those occurring at the surgical site and those that were systemic.
The total perioperative complication rate in the study was 20% (67 complications in 54 patients). Complications at the surgical site occurred in 22 patients (8.1%), and minor systemic complications (anemia, delirium, or urinary tract infection) occurred in 40 patients (14.8%). No patients experienced a major systemic complication (one that could be potentially life-threatening or lead to prolonged hospitalization), and no patients died. The rate of repeated operations was 4.1%.
To identify risk factors for perioperative complications, the authors examined:
- Surgical factors: Operative level, number of spinal levels treated, type of surgery, length of surgery, estimated blood loss
- Patient demographics: Age, sex, body mass index
- Preoperative health status
Each patient’s preoperative health status was determined by using the following measurements:
- Charlson Comorbidity Index
- American Society of Anesthesiologists Physical Status Classification System
- Eastern Cooperative Oncology Group Performance Status (ECOG-PS)
- Presence of sarcopenia
- Geriatric Nutritional Risk Index
Univariate and multivariate analyses identified spine surgery involving instrumentation (for example, inclusion of plates and screws), operations lasting more than 180 minutes, and the ECOG-PS (limited activities of daily living) as significant risk factors for minor systemic perioperative complications.
Older age itself, the presence of comorbidities, and being at nutritional risk were not found to be risk factors in this study. In addition, there were no severe complications.
On the basis of their findings, the authors conclude that it is safe to perform spine surgery in patients of advanced age. But spine surgeons should be aware of the risk factors for complications when preparing for surgery in the 80-and-older patient group.
Watanabe T, Kanayama M, Takahata M, Oda I, Suda K, Abe Y, Okumura J, Hojo Y, Iwasaki N. Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study. J Neurosurg Spine, published ahead of print December 17, 2019. doi: 10.3171/2019.9.SPINE19754.