Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors Clinical
Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors Clinical
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DOI：
10.3171/2011.7.spine10640
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发表时间：
2011-12-01
影响因子：
2.8
通讯作者：
Ondra, Stephen L.
中科院分区：
文献类型：
--
作者：
Acosta, Frank L., Jr.;McClendon, Jamal, Jr.;Ondra, Stephen L.
对象。随着人口持续老龄化，相对年长的老年患者将更频繁地出现复杂的脊柱畸形，可能需要手术干预。据作者所知，尚未有研究分析高龄（75岁及以上）脊柱畸形手术后并发症的预测因素。作者的目的是确定75岁及以上接受至少5节位关节融合术的主要脊柱畸形手术患者的次要和主要并发症的发生率及预测因素。回顾性分析了21例75岁及以上的患者，他们因脊柱畸形接受了5节段以上的胸椎和/或腰椎固定和关节融合术。详细审查了医疗和手术记录。记录年龄、诊断、合并症、手术资料、医院资料、主要和次要并发症以及死亡。通过logistic回归分析确定围手术期并发症的预测因素。患者平均年龄为77岁（75-83岁）。有14名女性和7名男性。平均随访41.2个月（24-81个月）。15例患者（71%）至少有1种合并症。平均融合10.5个节段（范围5-15个节段）。13例（62%）患者至少有1个围手术期并发症，8例（38%）患者至少有1个主要并发症，共17个并发症。无围手术期死亡。年龄增加可预测围手术期并发症（p = 0.03）。然而，主要并发症不能用年龄或合并症作为一个整体来预测。在合并症的亚组分析中，只有高血压可预测主要并发症（OR 10, 95% Cl 1.3-78; p = 0.02）。术后长期并发症11例（52%），需行翻修融合手术3例（14%）。75岁及以上接受脊柱大畸形手术的患者围手术期总并发症发生率为62%，年龄越大发生并发症的可能性越大，术后长期并发症发生率为52%。这个年龄段有高血压病史的患者发生重大围手术期并发症的可能性要高出10倍。然而，这些患者的死亡风险并没有增加。(DOI: 10.3171 / 2011.7.spine10640)
Object. As the population continues to age, relatively older geriatric patients will present more frequently with complex spinal deformities that may require surgical intervention. To the authors' knowledge, no study has analyzed factors predictive of complications after major spinal deformity surgery in the very elderly (75 years and older). The authors' objective was to determine the rate of minor and major complications and predictive factors in patients 75 years of age and older who underwent major spinal deformity surgery requiring a minimum 5-level arthrodesis procedure.Methods. Twenty-one patients who were 75 years of age or older and underwent thoracic and/or lumbar fixation and arthrodesis across 5 or more levels for spinal deformity were analyzed retrospectively. The medical and surgical records were reviewed in detail. Age, diagnosis, comorbidities, operative data, hospital data, major and minor complications, and deaths were recorded. Factors predictive of perioperative complications were identified by logistic regression analysis.Results. The mean patient age was 77 years old (range 75-83 years). There were 14 women and 7 men. The mean follow-up was 41.2 months (range 24-81 months). Fifteen patients (71%) had at least 1 comorbidity. A mean of 10.5 levels were fused (range 5-15 levels). Thirteen patients (62%) had at least 1 perioperative complication, and 8 (38%) had at least one major complication for a total of 17 complications. There were no perioperative deaths. Increasing age was predictive of any perioperative complication (p = 0.03). However, major complications were not predicted by age or comorbidities as a whole. In a subset analysis of comorbidities, only hypertension was predictive of a major complication (OR 10, 95% Cl 1.3-78; p = 0.02). Long-term postoperative complications occurred in 11 patients (52%), and revision fusion surgery was necessary in 3(14%).Conclusions. Patients 75 years and older undergoing major spinal deformity surgery have an overall perioperative complication rate of 62%, with older age increasing the likelihood of a complication, and a long-term postoperative complication rate of 52%. Patients in this age group with a history of hypertension are 10 times more likely to incur a major perioperative complication. However, the mortality risk for these patients is not increased. (DOI: 10.3171/2011.7.SPINE10640)