Introduction: The consequences of suffering postoperative complications in elderly undergoing spinal surgeries may be different compared with younger patients. The primary objective of this study was to identify the types and frequency of medical perioperative complications and mortality rates in patients 80 years of age or older undergoing elective spinal surgeries for degenerative spinal disease.
Methods: A prospective observational study with a retrospective chart review was performed, which included all consecutive patients > 80 years old undergoing elective spinal surgeries from May 2012 to August 2015. We identified 95 patients, 39 cervical and 56 lumbar surgeries were performed. There were 41 female and 54 male patients with the mean age of 82.8 years (range, 80 – 91). The perioperative complications were allocated into the following categories: infections, pulmonary, cardiac, gastrointestinal, hematologic, urologic, neurovascular, thromboembolic, and other complications. Baseline and postoperative clinical outcome scores were compared to evaluate efficacy.
Results: The mean follow-up time was 14.8 months (range, 5 days -37 months) with the overall mortality rate of 8.4%. The 30-day, 90-day, and 1-year mortality rates were 2.1%, 2.1%, and 4.2%, respectively. There were 53.9% and 71.4% patients with complications in the cervical and lumbar patient groups, respectively. The presence of general comorbidities, the number of intervertebral levels and instrumentation predicted the occurrence of perioperative complications. In addition, the longer OR time was associated with a higher number of complications per patient and occurrence of UTI. Dysphagia was a significant predictor to develop pneumonia and atelectasis.
Conclusions: The incidence of perioperative medical complications and mortality rates in octogenarians undergoing elective spinal surgeries are quite high. The benefits of having surgery must be weighed against the risks of not only surgical but also adverse medical events. It is important to identify potential complications and adapt preventive measures to minimize them in this patient population.
Patient Care: An informed consent process should include discussion of potential postoperative morbidity specific to this patient population in order to guide patient acceptance of higher risks and expectations postoperatively. It is also important to identify potential complications and adapt preventive measures to minimize them in this patient population.
Learning Objectives: The participants should be able to identify the types and frequency of medical complications in octogenarians undergoing spinal fusion surgeries.