A new study has come to the unexpected conclusion that elderly adult spinal deformity patients who undergo surgery recover significantly quicker than their younger counterparts. The study was published by the journal Spine.
The International Spine Study Group (ISSG) conducted a retrospective review of a multicentre, prospective adult spinal deformity database to test their hypothesis that increased age and increased pre-operative disability would negatively impact both the length of time needed to achieve maximal recovery and the amount of functional improvement achieved.
The justification for the hypothesis was that elderly adult spinal deformity patients generally have worse baseline health-related quality of life (HRQOL) measures than younger patients. “Current methods of reporting outcomes are limited, perhaps diminishing the health impact of the entire postoperative recovery experience,” the authors add.
In order to gauge the recovery process, the Study Group used a normalisation process to calculate an integrated health state over the two-year post-operative period.
The young patient group was made up of patients aged 45 or lower. The middle-aged group included patients aged 46–64 and the elderly group included those patients of 65 years or older.
HRQOL measures used included the Oswestry Disability Index (ODI), Short Form-36 (SF-36) questionnaire (with both physical and mental component scores), and Scoliosis Research Society-22 questionnaire (SRS-22) at baseline, six weeks, one and two years post-operatively. All HRQOL measures were normalised to each patient’s baseline scores. The study included a total of 149 patients (n=32 aged 45 or below, n=67 aged from 46–64 and n=50 aged 65 or above).
“Elderly patients had a shorter and improved recovery period compared to younger patients when normalised to their own pre-operative baseline values despite a higher complication rate,” report the authors. “In addition, patients with high pre-operative disability independent of age also had a better recovery process than those with lower baseline disability when patients are normalised to their baseline scores.”
All groups significantly improved in all HRQOL measures after two years compared with baseline scores (p<0.05) except for mental component scores, ODI, and SRS-22 activity for the aged 45 and younger group (p>0.05). Normalised integrated health state HRQOL scores for young patients were found to be worse than those of elderly patients for ODI, physical and mental component scores, SRS-22 activity, pain and total over the two-year recovery period from index surgery. The mild ODI group had significantly worse two-year IHS values than the HIGH group for all HRQOL measured (p<0.05) except SRS-22 appearance and satisfaction (p>0.05).
“Contrary to our hypothesis, an integrated health state analysis suggested that the recovery process was significantly better for elderly patients than young patients and better for patients with high baseline disability,” conclude the ISSG.