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

• Published in: International orthopaedics Vol. 42; no. 5; pp. 1083 - 1089
• Main Authors: Onda, Shingo, Kanayama, Masahiro, Hashimoto, Tomoyuki, Oha, Fumihiro, Iwata, Akira, Tanaka, Masaru, Kaneko, Kazuo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2018
• Subjects: Medicine; Medicine & Public Health; Original Paper; Orthopedics; Instrumentation surgery; Perioperative complications; Decompression; ASA-PS classification; Comorbidities; Elderly old patients
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-018-3875-1

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.