Complications and Mortality Following 1 to 2 Level Lumbar Fusion Surgery in Patients Above 80 Years of Age

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Abstract

Study Design.

Retrospective database review.

Objective.

To determine the 90-day complication rate and 90-day and 1-year mortality in patients 80 years of age and older who were treated with posterolateral lumbar spinal fusion surgery and to compare these rates against those of elderly patients ages 65 to 79.

Summary of Background Data.

Patients over 80 years of age specifically represent a substantial proportion of the US population, with over 11 million such individuals in 2010. Few studies have comprehensively assessed the morbidity associated with spinal fusion surgery in patients older than 80 years.

Methods.

The PearlDiver database (2005–2012) was utilized to determine morbidity and mortality rates after posterolateral lumbar or lumbosacral spinal fusion surgery of 2–3 vertebrae. Patients 65 to 79 (72,547) and ≥80-year old (12,187) were selected. Charlson comorbidity index scores were analyzed and compared, as were various comorbid conditions 90-day complication rates and mortality at 90-days and 1 year compared between cohorts.

Results.

The ≥80 year cohort had a higher average Charlson Comorbidity Index score than the 65 to 79 year cohort (7.99 vs. 6.54, P <0.0001). The proportion of patients experiencing at least one major complication was relatively increased by 45.6% in patients ≥80 year (13.87 vs. 9.52%; OR 1.53 95% CI 1.44 – 1.62 P <0.0001). Ninety-day (0.30 vs. 0.09%; OR: 3.50, 95% confidence interval: 2.33–5.26, P <0.0001) and 1-year (0.48 vs. 0.18%; OR: 2.58, 95% confidence interval: 1.90–3.52, P <0.0001) mortality were significantly higher in the ≥80 year cohort compared with the 65 to 79-year-old control group.

Conclusion.

Patients 80 years of age or older have significantly greater rates of major medical complication and mortality following 1 to 2 level lumbar spinal posterolateral fusion surgery compared with patients 65 to 79 years of age.

Conclusion.

Level of Evidence: 3

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