Spine surgery ‘safe’ in patients of advanced age

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Spine surgery in patients of advanced age is safe to perform as older age itself is not a risk factor, surgeons from seven institutions in Japan have concluded following a multicentre, prospective study of surgeries performed in patients 80 years of age and older.

The study, published in the Journal of Neurosurgery: Spine, sought to determine what perioperative complications of spine surgery are associated with patients in the advanced age group and to investigate the risk factors for perioperative systemic complications. Lead author Takamasa Watanabe (Hakodate Central General Hospital; Hokkaido; Japan) noted that spine surgery can improve quality of life in many patients with damaged or deteriorating spinal components and looked to establish whether spine surgery is advisable in over-80s, as well as the risks it carries. Watanabe wrote that with the world’s population steadily growing older “degenerative spine diseases constitute a common health problem in older persons”.

Seven spine centres with board-certified spine surgeons participated in the study. The patient group consisted of 270 patients, 80 years or older, who underwent elective spine surgery in 2017. Patients with tumours, infection, or trauma were not included. Perioperative complications were defined as adverse events occurring during surgery or within 30 days postoperatively. Complications were separated into those occurring at the surgical site and those that were systemic.

To identify risk factors for perioperative complications, the authors examined surgical factors—operative level, number of spinal levels treated, type of surgery, length of surgery, and estimated blood loss—as well as patient demographics—age, sex, and body mass index—and preoperative health status.

Each patient’s preoperative health status was determined by using the Charlson Comorbidity Index to predict survival based on comorbidities; the American Society of Anesthesiologists Physical Status Classification System, to assess the patient’s general condition; the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), used to evaluate patients’ ability to take care of themselves; the presence of sarcopenia—loss of muscle mass and strength—and the Geriatric Nutritional Risk Index to evaluate nutritional risk.

Both the univariate and multivariate analyses identified spine surgery involving instrumentation (for example, inclusion of plates and screws), operations lasting more than 180 minutes, and the ECOG-PS (limited activities of daily living) as significant risk factors for minor systemic perioperative complications.

The study’s authors found that the total perioperative complication rate in the cohort was 20% (67 complications in 54 patients). Complications at the surgical site occurred in 22 patients (8.1%), and minor systemic complications: anaemia, delirium, or urinary tract infection, occurred in 40 patients (14.8%). No patient experienced a major systemic complication (one that could be potentially life-threatening or lead to prolonged hospitalisation), and no patient died. The rate of repeated operations was 4.1%.

The authors suggest that spine surgeons be aware of these risk factors when preparing for surgery in this advanced-age patient group. Older age itself, the presence of comorbidities, and being at nutritional risk were not found to be risk factors. On the basis of their findings, the authors conclude that it is safe to perform spine surgery in patients of advanced age.


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