OBJECT The aging of the population will require that surgeons increasingly consider operating on elderly patients. Performing surgery safely in the elderly will require an understanding of the factors that predict successful outcomes and avoid complications. METHODS Records of patients 85 years and older undergoing elective lumbar spinal surgery were retrospectively reviewed. Microdiscectomies were excluded. Preexisting medical illnesses measured using the Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) Physical Status class, age, and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point scale. RESULTS During the study 26 consecutive patients (mean age 87 years) with a mean ASA class of 2.6 ± 0.65 and CCI of 1.1 ± 1.27 were enrolled. The average number of levels treated was 2.17 ± 1.23, and 73% underwent fusion. The mean follow-up was 41.9 months with a minimum of 24 months, and all patients were alive at last follow-up. Average blood loss was 142 ± 184 ml, and the operative time was 183.3 ± 80.6 minutes. The mean number of levels treated was 2.17 ± 1.13 (range 1-4). Ambulatory function improved significantly by 0.59 ± 1.0 points. Five complications (19.2%) occurred in 4 patients, 2 major and 3 minor. Four complications were temporary and 1 was permanent. Patient age, blood loss, CCI score, ASA class, the number of levels treated, and fusion surgery were not statistically associated with a complication. Operative time of longer than 180 minutes (p = 0.0134) was associated with complications. CONCLUSIONS Lumbar spine surgery in patients 85 years and older can be accomplished safely if careful attention is paid to preoperative selection. Prolonged operative times are associated with a higher risk of complications.
[1]
Alpesh A. Patel,et al.
Incidence and Mortality of Cardiac Events in Lumbar Spine Surgery
,
2013,
Spine.
[2]
C. Ames,et al.
Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors.
,
2011,
Journal of neurosurgery. Spine.
[3]
Jeffrey G Jarvik,et al.
Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.
,
2010,
JAMA.
[4]
W. Lauerman,et al.
Predicting Morbidity and Mortality of Lumbar Spine Arthrodesis in Patients in Their Ninth Decade
,
2006,
Spine.
[5]
M. Lehto,et al.
Factors influencing the outcome of operative treatment for lumbar spinal stenosis
,
1995,
Acta Neurochirurgica.
[6]
John R. Johnson,et al.
Perioperative complications of posterior lumbar decompression and arthrodesis in older adults.
,
2003,
The Journal of bone and joint surgery. American volume.
[7]
B. Green,et al.
Complications associated with lumbar stenosis surgery in patients older than 75 years of age.
,
2003,
Neurosurgical focus.
[8]
F. Cammisa,et al.
Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery.
,
2001,
Journal of spinal disorders.
[9]
S R Garfin,et al.
Predicting Complications in Elderly Patients Undergoing Lumbar Decompression
,
2001,
Clinical orthopaedics and related research.
[10]
J. Maroon,et al.
Lumbar surgery in the elderly.
,
1992,
Neurosurgery.
[11]
C. Mackenzie,et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
,
1987,
Journal of chronic diseases.