Complications and Mortality in Octogenarians Undergoing Lumbopelvic Fixation.

Publication Title

World Neurosurg

Authors

Alexander von Glinski, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Hansjörg Wyss Hip and Pelvic Center, Swedish Medical Center, Seattle, Washington, USA
Christopher Elia, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Darius Ansari, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Emre Yilmaz, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
Ariel Takayanagi
Daniel C Norvell
Clifford A Pierre, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Amir Abdul-Jabbar, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Jens R Chapman, Swedish Neuroscience InstituteFollow
Rod J Oskouian, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow

Document Type

Article

Publication Date

2-1-2020

Keywords

Adult; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Middle Aged; Mortality; Pelvic Bones; Postoperative Complications; Retrospective Studies; Spinal Fusion; Lumbopelvic fixation; Morbidity; Mortality; Octogenarian; Spine surgery

Abstract

BACKGROUND: Advancements in modern medicine have led to longer life expectancy. Literature on spinopelvic fixation in elderly patients is limited. We investigated morbidity and mortality in octogenarians who underwent spinopelvic fixation.

METHODS: A retrospective chart review was conducted of patients who underwent spinopelvic fixation from January 2014 through December 2018 at a single institution. Patients were grouped into the octogenarian group (OG), 80-89 years old, and comparison group (CG), 40-50 years old. Demographics; pathology; Charlson Comorbidity Index; Hounsfield units; surgery details; and clinical data including complications, intensive care unit and length of hospital stay, and mortality were collected and compared.

RESULTS: Inclusion criteria were met by 26 patients (OG: n = 14; CG: n = 12). Diagnoses in the OG were deformity (42.9%), pseudarthrosis (35.7%), fracture (7.1%), infection (7.1%), and tumor (7.1%). The only significant differences in baseline patient characteristics were that Charlson Comorbidity Index was significantly higher in the OG (6.0 ± 1.4) compared with the CG (1.1 ± 1.0) (P < 0.001) and the OG had lower Hounsfield units (P < 0.001), indicating poorer bone quality. More patients in the CG underwent staged and anterior approaches compared with the OG (P = 0.031). Major and minor complication rates were 57.1% and 42.9%, respectively, in the OG (P = 0.98) and 25% and 25% in the CG (P = 0.34). Mortality rate was 14.3%.

CONCLUSIONS: With an aging population, the number of patients requiring spinopelvic fixation will continue to grow. Spine surgeons must carefully weigh benefits and risks in patients with multiple comorbidities.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences