How old is too old?: Matched analysis of geriatric patients undergoing anterior lumbar interbody fusion

• Published in: Clinical neurology and neurosurgery Vol. 212; p. 107090
• Main Authors: Kamalapathy, Pramod N., Vatani, Jasmine, Raso, Jon, Hassanzadeh, Hamid, Li, Xudong
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2022; Elsevier Limited
• Subjects: Age; Age Factors; Age groups; Aged; Aged, 80 and over; Back surgery; Bone surgery; Comorbidity; Complication; Databases, Factual; Female; Fusion; Gender; Geriatric; Geriatrics; Humans; Length of stay; Life expectancy; Lumbar; Lumbar Vertebrae - surgery; Male; Middle Aged; Older people; Outcome Assessment, Health Care - statistics & numerical data; Patients; Pneumonia; Population; Postoperative Complications - epidemiology; Retrospective Studies; Sepsis; Spinal Fusion - adverse effects; Spinal Fusion - statistics & numerical data; Spine (lumbar); Statistical analysis; Surgical outcomes; Surgical site infections; United States > US; Colorado; Complication; Lumbar; Fusion; Geriatric; Age
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.107090

Retrospective Review The aim of this study is to utilize a national database to identify how age affects patient outcomes following anterior lumbar interbody fusion (ALIF). There are no established age guidelines for the geriatric population within the spine specialty, which makes patient selection challenging. Furthermore, there are conflicting studies for the risks of performing spine surgeries in the elderly. A retrospective review of the Mariner Claims Database was conducted on patients who underwent a single level ALIF (CPT 22558) between 2010 and 2018. Patients were separated into three groups by age: 50–64, 65–74, and 75–84 and matched with respect to gender, smoking, and comorbidity burden. Multivariable logistic regression was used to determine the independent effect of outpatient surgery on the postoperative outcomes after adjusting for demographic factors and pertinent comorbidities. Statistical significance was set at p < 0.05. The study identified 8459 matched patients (3350 50–64; 3350 65–74; and 1759 75–84). Compared with patients aged 50–64, patients aged 65–74 and 75–84 had significantly increased risks of pneumonia (65–74: OR 1.53, 95% CI 1.06–2.24, p = 0.025; 75–84: OR 1.62, 95% CI 1.07–2.42, p = 0.022), sepsis (65–74: OR 2.20, 95% CI 1.36–3.76, p = 0.002; 75–84: OR 2.42, 95% CI 1.43–4.13, p = 0.001), and major complications (65–74: OR 1.35, 95% CI 1.05–1.74, p = 0.021; 75–84: OR 1.48, 95% CI 1.11–1.95, p = 0.006) (Table 2). There were no significant differences between patients aged 65–74 and 75–84 for risks of postoperative pneumonia, sepsis, and major complications (p > 0.05). There were no differences between any groups in terms of long-term outcomes such as pseudoarthrosis, implant related complications, or reoperation (p > 0.05) (Table 3). The study showed that those older than 65 had a significant increase in risk of pneumonia, sepsis, and major complications following ALIF. In the two cohorts above the age of 65 (65–74 and 75–84) there was no significant differences in postoperative outcomes. 3 •8,459 matched patients undergoing single-level ALIF were split into three groups by age 50–64; 65–74; and 75–84.•Compared to the <65 cohort, age = 65 was associated with an increased risk of pneumonia, sepsis, and major complications.