International Orthopaedics

, Volume 42, Issue 5, pp 1083–1089 | Cite as

Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study

  • Shingo Onda
  • Masahiro Kanayama
  • Tomoyuki Hashimoto
  • Fumihiro Oha
  • Akira Iwata
  • Masaru Tanaka
  • Kazuo Kaneko
Original Paper
  • 38 Downloads

Abstract

Purpose

To compare peri-operative complication rates in ≥ 85-year-old patients who underwent decompression surgery with or without instrumented fusion for degenerative disorders.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Perioperative complications Decompression Instrumentation surgery Elderly old patients Comorbidities ASA-PS classification 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

References

  1. 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
  2. 2.
    Shabat S, Folman Y, Leitner Y, Fredman B, Gepstein R (2007) Failure of conservative treatment for lumbar spinal stenosis in elderly patients. Arch Gerontol Geriatr 44(3):235–241.  https://doi.org/10.1016/j.archger.2006.05.003 CrossRefPubMedGoogle Scholar
  3. 3.
    Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, Sharan AD, Ratliff JK (2010) Complications in spine surgery. J Neurosurg Spine 13(2):144–157.  https://doi.org/10.3171/2010.3.SPINE09369 CrossRefPubMedGoogle Scholar
  4. 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. 5.
    Izumida SI,S (1986) Assessment of treatment for low back pain. J Jpn Orthop Assoc 60:391–394Google Scholar
  6. 6.
    Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303(13):1259–1265.  https://doi.org/10.1001/jama.2010.338 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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
  8. 8.
    Epstein NE (2011) Spine surgery in geriatric patients: sometimes unnecessary, too much, or too little. Surg Neurol Int 2:188.  https://doi.org/10.4103/2152-7806.91408 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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
  10. 10.
    Goswami S, Brady JE, Jordan DA, Li G (2012) Intraoperative cardiac arrests in adults undergoing noncardiac surgery: incidence, risk factors, and survival outcome. Anesthesiology 117(5):1018–1026.  https://doi.org/10.1097/ALN.0b013e31827005e9 CrossRefPubMedGoogle Scholar
  11. 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
  12. 12.
    Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(3):424–429.  https://doi.org/10.1111/j.1532-5415.2005.53159.x CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Shingo Onda
    • 1
  • Masahiro Kanayama
    • 2
  • Tomoyuki Hashimoto
    • 2
  • Fumihiro Oha
    • 2
  • Akira Iwata
    • 2
  • Masaru Tanaka
    • 2
  • Kazuo Kaneko
    • 1
  1. 1.Department of Orthopedics SurgeryJuntendo UniversityTokyoJapan
  2. 2.Spine CenterHakodate Central General HospitalHakodateJapan

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