Spine deformity surgery in the elderly: risk factors and 30-day outcomes are comparable in posterior versus combined approaches

Abstract

Objectives

Risk factors portending poor outcome following elective spine deformity fusion remain in need of characterization and stratification in the elderly population.

Methods

Cases aged ≥60 years who underwent elective posterior or anterior-posterior (‘combined’) fusion were extracted from the American College of Surgeons National Surgical Quality Improvement Program years 2007–2013 and analyzed by surgical cohort (posterior vs. combined). The 30-day outcomes included operation time, hospital length of stay (HLOS), perioperative complications, and discharge destination. Multivariable regressions controlling for demographic/clinical variables were performed. Odds ratios (OR) and mean differences (B) were reported with 95% confidence intervals (CI).

Results

A total of 881 cases (18.2% combined; 81.8% posterior) aged 70 ± 6.2 years, 32.8% male, and 87.2% Caucasian were included. Posterior fusions associated with extreme body habitus (obese class II/III and underweight; P = 0.027), functional independence (97.5% vs. 91.8%; P = 0.010), and multi-level fusions (7–12 levels: 24.8% vs. 18.1%; ≥13 levels: 8.9% vs. 3.1%; P = 0.004). Overall operation time was 338.0 ± 150.2-min and HLOS 7.4 ± 6.6-days; 17.1% suffered early complications and 54.5% were discharged home. On multivariable analysis, combined (B = 63.8-min; P < 0.001), and multi-level fusions (7–12: 61.0-min; P < 0.001; ≥13: 133.8-min; p < 0.001) associated with increased operation time. HLOS increased for multi-level fusions (7–12 levels: 1.3-days; P = 0.012; ≥13 levels: 2.2-days; P = 0.008). Overall complications did not differ by cohort or levels; on post hoc analysis combined fusions associated with pneumonia (OR = 3.05; P = 0.008). Multi-level fusions showed decreased odds of discharge home (7–12 levels: OR = 0.57; P = 0.003; ≥13-levels: OR = 0.41; P = 0.003).

Conclusions

The 30-day outcomes and early perioperative complications are comparable for posterior vs. combined approaches to correct deformity in the elderly. Multi-level fusions are associated with increased operation time, HLOS, and discharge to higher level of care.

Keywords:

• Anterior-posterior fusion
• complications
• elderly
• length of stay
• multi-level fusion
• operation time
• outcomes
• posterior fusion
• spine deformity
• spine surgery

Acknowledgments

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.