The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis

Smith, Colleen; Lamba, Nayan; Ou, Zhishuo; Vo, Quynh-Anh; Araujo-Lama, L.; Lim, Sanghee; Joshi, Dhaivat; Doucette, Joanne; Papatheodorou, Stefania; Tafel, Ian; Aglio, Linda S.; Smith, Timothy R.; Mekary, Rania A.; Zaidi, Hasan A.

doi:10.21037/jss.2019.03.06

Cited by 19 publications

(9 citation statements)

References 45 publications

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“…[1][2][3][4] However, surgical treatment of spinal deformities for elderly patients remains challenging because of the high rates of surgical and medical complications. 5,6 Therefore, many investigators have tried to determine the incidence of and risk factors for perioperative complications associated with the surgical treatment of ASD. In those studies, infections, neurologic deficits, cardiopulmonary complications, cerebrovascular accident and deep venous thrombosis were identified as major complications.…”

Section: Introductionmentioning

confidence: 99%

Clinical Importance, Incidence and Risk Factors for the Development of Postoperative Ileus Following Adult Spinal Deformity Surgery

Ohba

Koyama

Oba

et al. 2020

Global Spine Journal

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Study Design: Retrospective observational study of a cohort of consecutive patients. Objectives: Postoperative ileus (POI) is associated with a variety of adverse effects. Although the incidence of and risk factors for POI following spinal surgery have been reported, the frequency and pathology of POI after spinal corrective surgery for adult spinal deformity (ASD) are still largely unknown. The study objectives were to: (1) clarify the prevalence and clinical significance of POI, (2) elucidate the risk factors for POI, (3) determine radiographically which preoperative and/or postoperative spinal parameters predominantly influence the risk of POI after spinal corrective surgery for ASD. Methods: We included data from 144 consecutive patients who underwent spinal corrective surgery. Perioperative medical complications and clinical information were extracted from patient electronic medical records. Preoperative radiographic parameters and changes in radiographic parameters after surgery were compared between patients with and without POI. Multivariate logistic regression analyses were performed to clarify potential risk factors for POI. Results: POI developed in 25/144 (17.4%) patients and was the most common complication in the present study. The frequencies of smoking, gastroesophageal reflux disease, and lateral lumbar interbody fusion (LLIF), as well as the duration of surgery were significantly greater in the group with POI versus the group without POI. Among radiographic parameters, only the change in thoracolumbar kyphosis (TLK) from before to after surgery was significantly larger in the group with POI. Multivariate logistic regression analysis showed that male sex, LLIF and large changes in TLK from before to after surgery were significantly associated with the development of POI. Conclusions: These results suggested that LLIF and large corrections in TLK were independent risk factors for POI after ASD surgery. When patients with ASD have large TLK preoperatively, and it is determined that a large correction is needed, physicians must be aware of the potential for occurrence of POI.

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Section: Introductionmentioning

confidence: 99%

Clinical Importance, Incidence and Risk Factors for the Development of Postoperative Ileus Following Adult Spinal Deformity Surgery

Ohba

Koyama

Oba

et al. 2020

Global Spine Journal

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“…For example, large multicenter studies have reported complications divided into intraoperative or postoperative, surgical or medical, major or minor, neurologic or radiographic, and early or late classes. [35][36][37][38][39][40][41] Lee et al described perioperative complications in 200 patients surgically treated for spinal metastases and described an overall complication rate of 16.5%. 20 These included wound dehiscence (4.5%), pneumonia (3.5%), epidural hematoma (2.5%) acute renal failure (2.5%), sepsis (2.5%), hepatic failure (1.0%) and cardiac arrest (1.0%).…”

Section: Discussionmentioning

confidence: 99%

Surgery for Metastatic Spinal Disease in Octogenarians and Above: Analysis of 78 Patients

Hussain

Hartley

McLaughlin

et al. 2021

Global Spine Journal

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Study Design: Retrospective Cohort Study. Objective: Octogenarians living with spinal metastases are a challenging population to treat. Our objective was to identify the rate, types, management, and predictors of complications and survival in octogenarians following surgery for spinal metastases. Methods: A retrospective review of a prospectively collected cohort of patients aged 80 years or older who underwent surgery for metastatic spinal tumor treatment between 2008 and 2019 were included. Demographic, intraoperative, complications, and postoperative follow-up data was collected. Cox proportional hazards regression and logistic regression were used to associate variables with overall survival and postoperative complications, respectively. Results: 78 patients (mean 83.6 years) met inclusion criteria. Average operative time and blood loss were 157 minutes and 615 mL, respectively. The median length of stay was 7 days. The overall complication rate was 31% (N = 24), with 21% considered major and 7% considered life-threatening or fatal. Blood loss was significantly associated with postoperative complications (OR = 1.002; P = 0.02) and mortality (HR = 1.0007; P = 0.04). Significant associations of increased risk of death were also noted with surgeries with decompression, and cervical/cervicothoracic index level of disease. For deceased patients, median time to death was 4.5 months. For living patients, median follow-up was 14.5 months. The Kaplan-Meier based median overall survival for the cohort was 11.6 months (95% CI: 6.2-19.1). Conclusions: In octogenarians undergoing surgery with instrumentation for spinal metastases, the median overall survival is 11.6 months. There is an increased complication rate, but only 7% are life-threatening or fatal. Patients are at increased risk for complications and mortality particularly when performing decompression with stabilization, with increasing intraoperative blood loss, and with cervical/cervicothoracic tumors.

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“…Spine deformity affects 30%-70% of the elderly population (1), and spine surgery for degenerative conditions has continued to rise over the past two decades (2)(3)(4). Optimizing outcomes and reducing complications in this growing population is paramount.…”

Section: Introductionmentioning

confidence: 99%

A standardized postoperative bowel regimen protocol after spine surgery

et al. 2023

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ObjectivesSpine surgery is associated with early impairment of gastrointestinal motility, with postoperative ileus rates of 5–12%. A standardized postoperative medication regimen aimed at early restoration of bowel function can reduce morbidity and cost, and its study should be prioritized.MethodsA standardized postoperative bowel medication protocol was implemented for all elective spine surgeries performed by a single neurosurgeon from March 1, 2022 to June 30, 2022 at a metropolitan Veterans Affairs medical center. Daily bowel function was tracked and medications were advanced using the protocol. Clinical, surgical, and length of stay data are reported.ResultsAcross 20 consecutive surgeries in 19 patients, mean age was 68.9 years [standard deviation (SD) = 10; range 40–84]. Seventy-four percent reported preoperative constipation. Surgeries consisted of 45% fusion and 55% decompression; lumbar retroperitoneal approaches constituted 30% (10% anterior, 20% lateral). Two patients were discharged in good condition prior to bowel movement after meeting institutional discharge criteria; the other 18 cases all had return of bowel function by postoperative day (POD) 3 (mean = 1.8-days, SD = 0.7). There were no inpatient or 30-day complications. Mean discharge occurred 3.3-days post-surgery (SD = 1.5; range 1–6; home 95%, skilled nursing facility 5%). Estimated cumulative cost of the bowel regimen was $17 on POD 3.ConclusionsCareful monitoring of return of bowel function after elective spine surgery is important for preventing ileus, reducing healthcare cost, and ensuring quality. Our standardized postoperative bowel regimen was associated with return of bowel function within 3 days and low costs. These findings can be utilized in quality-of-care pathways.

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The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis

Cited by 19 publications

References 45 publications

Clinical Importance, Incidence and Risk Factors for the Development of Postoperative Ileus Following Adult Spinal Deformity Surgery

Clinical Importance, Incidence and Risk Factors for the Development of Postoperative Ileus Following Adult Spinal Deformity Surgery

Surgery for Metastatic Spinal Disease in Octogenarians and Above: Analysis of 78 Patients

A standardized postoperative bowel regimen protocol after spine surgery

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