Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis
Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis
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生理年龄在确定75岁以上患者成人脊柱畸形手术指征中的重要性：倾向评分匹配分析
DOI：
10.1007/s00586-022-07379-5
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发表时间：
2022
期刊：
影响因子：
2.8
通讯作者：
Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis
中科院分区：
文献类型：
--
作者：
Fujii Takayuki;Murata Koichi;Mun Se-Hwan;Bae Seyeon;Lee Ye Ji;Pannellini Tannia;Kang Kyuho;Oliver David;Park-Min Kyung-Hyun;Ivashkiv Lionel B.;竹原俊幸;Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis
目的从生理上讲，人们衰老的速度不同，这导致生理年龄和实际年龄之间的差异。在考虑成人脊柱畸形(ASD)手术的适应证时，生理年龄应该是优先考虑的因素。这项研究的主要目的是确定术后病程、手术结果和并发症发生率的特点，以延长老年自闭症患者(≥ 75岁)的健康预期寿命。第二个目的是阐明生理年龄在老年ASD患者手术治疗中的重要性，考虑到老年ASD患者的虚弱。方法对2015年至2019年连续10 9例 ≥ 65岁有症状的ASD患者行下胸椎至骨盆矫正长融合侧方椎间融合术。根据年龄将患者分为两组(Y组[65~74岁]，O组[≥ 75岁])，并根据ASD脆弱指数分为四组(Y-F组、Y-NF组、O-F组和O-NF组)。为了说明围术期病程特征、并发症发生率和手术结果的潜在危险因素，数据库中的患者接受了基于性别、体重指数和术前脊柱矢状面排列(C7矢状轴、骨盆倾角-腰椎前凸和骨盆倾斜)的倾向性评分匹配。术后2年，使用患者报告的三种与健康相关的生活质量结果测量方法评估临床结果：OSwestry残疾指数、脊柱侧弯研究学会问卷(SRS-22)和简明表格36(SF-36)。结果在Y组和O组比较中，O组患者发生轻微并发症(神志不清和尿路感染)的风险较高。与Y-F组比较，O-NF组患者术后除SRS-22(满意度)和术后下地活动时间外，其余结果与Y-F组相似，差异无统计学意义(P>0.05)。然而，ASD手术的结果更多地取决于虚弱而不是年龄。没有虚弱的老年ASD患者可以耐受矫正手术，并在使用微创技术时获得满意的结果。在确定老年ASD患者的手术适应证时，生理年龄比实际年龄更重要。
PurposePhysiologically, people age at different rates, which leads to a discrepancy between physiological and chronological age. Physiological age should be a priority when considering the indications for adult spinal deformity (ASD) surgery. The primary objective of this study was to determine the characteristics of the postoperative course, surgical outcomes, and complication rates to extend the healthy life expectancy of older ASD patients (≥ 75 years). The secondary objective was to clarify the importance of physiological age in the surgical treatment of older ASD patients, considering frailty.MethodsA retrospective review of 109 consecutive patients aged ≥ 65 years with symptomatic ASD who underwent a corrective long fusion with lateral interbody fusion from the lower thoracic spine to the pelvis from 2015 to 2019 was conducted. Patients were classified into two groups according to age (group Y [65–74 years], group O [≥ 75 years]) and further divided into four groups according to the ASD-frailty index score (Y-F, Y-NF, O-F, and O-NF groups). To account for potential risk factors for perioperative course characteristics, complication rates, and surgical outcomes, patients from the database were subjected to propensity score matching based on sex, BMI, and preoperative sagittal spinal alignment (C7 sagittal vertical axis, pelvic incidence-lumbar lordosis, and pelvic tilt). Clinical outcomes were evaluated 2 years postoperatively, using three patient-reported outcome measures of health-related quality of life: the Oswestry Disability Index, Scoliosis Research Society questionnaire (SRS-22), and Short Form 36 (SF-36). Additionally, the postoperative time-to-first ambulation, as well as minor, major, and mechanical complications, were evaluated.ResultsIn the comparison between Y and O groups, patients in group O were at a higher risk of minor complications (delirium and urinary tract infection). In contrast, other surgical outcomes of group O were comparable to those of group Y, except for SRS-22 (satisfaction) and time to ambulation after surgery, with better outcomes in Group O. Patients in the O-NF group had better postoperative outcomes (time to ambulation after surgery, SRS-22 (function, self-image, satisfaction), SF-36 [PCS]) than those in the Y-F group.ConclusionsOlder age warrants monitoring of minor complications in the postoperative management of patients. However, the outcomes of ASD surgery depended more on frailty than on chronological age. Older ASD patients without frailty might tolerate corrective surgery and have satisfactory outcomes when minimally invasive techniques are used. Physiological age is more important than chronological age when determining the indications for surgery in older patients with ASD.
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DOI：
10.1201/9781315154053-41
发表时间：
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期刊：
50 Landmark Papers
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DOI：
10.1016/j.jamda.2013.03.022
发表时间：
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影响因子：
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Morley JE;Vellas B;van Kan GA;Anker SD;Bauer JM;Bernabei R;Cesari M;Chumlea WC;Doehner W;Evans J;Fried LP;Guralnik JM;Katz PR;Malmstrom TK;McCarter RJ;Gutierrez Robledo LM;Rockwood K;von Haehling S;Vandewoude MF;Walston J
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