Postoperative Complications Associated With Spine Surgery in Patients Older Than 90 Years: A Multicenter Retrospective Study

Kobayashi, Kazuyoshi; Imagama, Shiro; Sato, Koji; Kato, Fumihiko; Kanemura, Tokumi; Yoshihara, Hisatake; Sakai, Yoshihito; Shinjo, Ryuichi; Hachiya, Yudo; Osawa, Yusuke; Matsubara, Yumiko; Ando, Kei; Nishida, Yoshihiro; Ishiguro, Naoki

doi:10.1177/2192568218767430

Cited by 41 publications

(36 citation statements)

References 34 publications

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“…EBL is a well-established risk factor for perioperative complication in spine surgery [4,22,23]. Our study supports this association, finding that EBL >500 mL is associated with more than threefold greater odds of medical complication (p=0.02).…”

Section: Discussionsupporting

confidence: 86%

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery

et al. 2019

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Objective: This retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery. Methods: Adults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery. Results: A total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p = 0.02) and estimated blood loss over 500 mL (OR, 3.67; p = 0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p = 0.02) and operative time (OR, 1.005; p = 0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p = 0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p = 0.04) and higher intraoperative blood loss (OR, 1.0007; p = 0.03). Conclusion: Preoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery.

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Section: Discussionsupporting

confidence: 86%

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery

et al. 2019

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“…7,8 Demands for spinal fusion procedures have increased as a result of the rising elderly population and morbidity associated with open fusion procedures, including substantial blood loss, increased complication rate, and longer hospital stays, may expose this patient population to undesirable surgical risks. 9-14…”

Section: Introductionmentioning

confidence: 99%

Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study

Kobayashi

Ando

Kato

et al. 2018

Global Spine Journal

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Study Design: Retrospective analysis of a prospectively database. Objectives: To identify factors associated with prolonged length of stay (LOS) in posterior /transforaminal lumbar interbody fusion (PLIF/TLIF). Methods: The subjects were patients who underwent PLIF/TLIF at 10 facilities from 2012 to 2014. A total of 1168 such patients with a mean age of 65.9 ± 12.5 years (range 18-87 years) were identified in the database. Operations were PLIF (n = 675), TLIF (n = 443), minimally invasive surgery (MIS)-PLIF (n = 22), and MIS-TLIF (n = 32). Age, gender, body mass index, ambulatory status, comorbidities, perioperative American Society of Anesthesiologists (ASA) grade, operative factors, and complications were examined. LOS was defined as the number of calendar days from the operation to hospital discharge. LOS was categorized as normal (<75th percentile) or prolonged (≥75th percentile). Results: The average LOS was 20.8 ± 9.8 days (range 7-77 days). There was a significant correlation between LOS and age ( P < .05). Reoperation during hospitalization was performed in 20 cases for surgical site infection (n = 12), epidural hematoma (n = 5), and screw misplacement (n = 3). In multivariate analysis, prolonged LOS was associated with preoperative variables of age ≥70 years (odds ratio [OR] 1.87, 95% CI 1.38-2.54), and ASA class ≥III (OR 1.52, 95% CI 1.04-2.25); surgical variables of open procedures (OR 5.84, 95% CI 1.74-19.63), fused levels ≥3 (OR 5.17, 95% CI 3.17-8.43), operative time ≥300 minutes (OR 1.88, 95% CI 1.15-3.07), and estimated blood loss ≥500 mL (OR 1.71, 95% 1.07-2.75). Conclusions: The factors identified in this study should help with obtaining informed consent, surgical planning and complication prevention to reduce health care costs associated with prolonged LOS.

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“…However, the high bleeding risk and difficult surgical technique limit the general application of spinal osteotomy for OVCF. In particular, elderly patients had a higher rate of major postoperative complications, which were defined as life‐threatening and requiring reoperation. Increased age, comorbidities, blood loss, operative time, and number of levels are the risk factors for these complications.…”

Section: Discussionmentioning

confidence: 99%

Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures

Kim

Chung

Park

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the cases of osteoporotic compression fracture with kyphotic deformity treated with modified pedicle subtraction osteotomy and analyze the usefulness of this osteotomy.Methods: Twenty patients (nine men, 11 women; mean age, 66.4 years; mean follow-up duration, 39.6 months) who underwent modified pedicle subtraction osteotomy at our hospital between November 2003 and July 2012 with a minimum follow-up period of 2 years were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high-energy trauma. The mean bone mineral density-dual energy x-ray absorptiometry (BMD-DEXA) was 0.673 g/cm 2 (0.571-0.740 g/cm 2 ), which was -2SD below normal, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. We evaluated Japanese Orthopaedic Association scores, Oswestry Disability Index scores, bone union, change in kyphotic angle, estimated blood loss, complications, and the patient's overall clinical satisfaction.Results: The collapsed vertebrae were thoracic (T 9, 11, 12 ) in 13 cases and lumbar (L 1 ) in seven cases. The mean pre-and post-operative kyphotic angles were 26.2 AE 9.9 degrees and 8.3 AE 8.1 degrees, showing an 18.3-degree correction. Plain radiography at the last follow-up showed a mean angle of 17.9 AE 12.6 degrees, indicating a 9.5-degree correction loss. The overall correction was 8.2 degrees. Bony union was achieved at the last follow-up in all cases. Clinical outcomes showed improvement in mean Japanese Orthopaedic Association score from 13.2 to 21.7 and mean Oswestry Disability Index score from 40.3 to 13.6. Overall clinical patient satisfaction showed 12 excellent results, five moderate results, and three poor results. Mean operation time was 4.2 h (range, 4-6 h). The overall mean estimated blood loss (EBL) was 1098 mL (range, 750-1370 mL). The mean hospital stay was 3.6 weeks (range, 2-6 weeks). There was one case of cauda equina syndrome at 2 days postoperatively, and two cases of screw loosening. There were no cases of distal junctional kyphosis, but there were two cases of proximal junctional kyphosis.Conclusions: Despite limited correction of kyphotic angle, our modified pedicle subtraction osteotomy technique resulted in satisfactory outcomes in our patients, who had persistent severe back pain, increased kyphotic angle with pseudarthrosis, and progressive neurologic deficits. Nevertheless, this procedure requires careful follow-up and strict surgical indications because of the risk of neurological damage and technical problems.

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Postoperative Complications Associated With Spine Surgery in Patients Older Than 90 Years: A Multicenter Retrospective Study

Cited by 41 publications

References 34 publications

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery

Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study

Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures

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