Introduction: Spine surgery in octogenarians has not been retrospectively reviewed, nationally, to assess the safety of decompression, discectomy, fusion and instrumentation, and re-fusion. Our aim was to analyze the risks of these spinal procedures in this growing population.
Methods: We identified patients in Thomson Reuters MarketScan database who underwent spine surgery 2000-2012. Current procedural terminology (CPT) coding at inpatient visit was used to select for procedure. Comorbidities and complications were obtained. Outcome measures included length of stay (LOS), in-hospital mortality, and in-hospital complication rates.
Results: The study analyzed 14,108 surgically treated patients over age 80 years (mean 83.03) with primary diagnosis of spinal stenosis and disc herniation/ protrusion who underwent fusion, re-fusion, decompression and discectomy. Univariate analysis showed: increased LOS following re-fusion (mean 5.84 days) versus all other surgeries: fusion (mean 4.59 days), decompression (mean 3.36 days), discectomy (mean 3.17 days) (p<.0001); increased rates of in-hospital mortality in those undergoing fusion versus decompression, and discectomy; in-hospital complications were similar in those undergoing fusion and decompression, mildly increased in discectomy patients and decreased in re-fusion patients (p<.0001). Multivariate analysis compared mortality, LOS, and complication between procedure type, gender, age at diagnosis, and diagnosis type. Mortality and LOS odds ratios (95% confidence interval) increased in discectomy (0.991) and re-fusion patients (1.262). Complication odds ratio were similar in re-fusion (0.609), decompression (0.659), and discectomy patients (0.699).
Conclusions: All types of spinal surgeries in octogenarians were associated with significant morbidities. Fusion surgery was associated with increased in-hospital mortality, re-fusion with increased LOS, decompression and discectomy with more in-hospital complications. Moreover, re-fusion and discectomy were associated with higher odds of mortality and LOS. Care should be taken in the selection of candidates over 80 years old for surgical intervention due to the significantly high risk profile.
Patient Care: For surgeons considering whether to perform a Discectomy with or without fusion for a octogenarian, this research will help the surgeon by giving them a risk profile from which to understand whether they should operate or not operate on their elderly patient
Learning Objectives: To help surgeons understand the risk of surgery in Octogenarians.