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Quiceno E, Seaman S, Hussein A, Dholaria N, Pico A, Abdulla E, Bauer IL, Nosova K, Moniakis A, Khan MA, Deaver C, Barbagli G, Prim M, Baaj A. Clinical Outcomes and Complication Profile of Spine Surgery in Septuagenarians and Octogenarians: Case Series. World Neurosurg 2024; 185:e878-e885. [PMID: 38453010 DOI: 10.1016/j.wneu.2024.02.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The aging global population presents an increasing challenge for spine surgeons. Advancements in spine surgery, including minimally invasive techniques, have broadened treatment options, potentially benefiting older patients. This study aims to explore the clinical outcomes of spine surgery in septuagenarians and octogenarians. METHODS This retrospective analysis, conducted at a US tertiary center, included patients aged 70 and older who underwent elective spine surgery for degenerative conditions. Data included the Charlson Comorbidity Index (CCI), ASA classification, surgical procedures, intraoperative and postoperative complications, and reoperation rates. The objective of this study was to describe the outcomes of our cohort of older patients and discern whether differences existed between septuagenarians and octogenarians. RESULTS Among the 120 patients meeting the inclusion criteria, there were no significant differences in preoperative factors between the age groups (P > 0.05). Notably, the septuagenarian group had a higher average number of fused levels (2.36 vs. 0.38, P = 0.001), while the octogenarian group underwent a higher proportion of minimally invasive procedures (P = 0.012), resulting in lower overall bleeding in the oldest group(P < 0.001). Mobility outcomes were more favorable in septuagenarians, whereas octogenarians tended to maintain or experience a decline in mobility(P = 0.012). A total of 6 (5%) intraoperative complications and 12 (10%) postoperative complications were documented, with no statistically significant differences observed between the groups. CONCLUSIONS This case series demonstrates that septuagenarians and octogenarians can achieve favorable clinical outcomes with elective spine surgery. Spine surgeons should be well-versed in the clinical and surgical care of older adults, providing optimal management that considers their increased comorbidity burden and heightened fragility.
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Affiliation(s)
- Esteban Quiceno
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA.
| | - Scott Seaman
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Amna Hussein
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Nikhil Dholaria
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Annie Pico
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Ebtesam Abdulla
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Isabel L Bauer
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Kristin Nosova
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | | | - Monis Ahmed Khan
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Courtney Deaver
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Giovanni Barbagli
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Michael Prim
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Ali Baaj
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
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Sakai K, Ikeda N, Fukumura M, Omura N, Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Kajimoto Y, Miyatake SI, Yokoyama K, Kawanishi M, Fujishiro T, Tanabe H, Wanibuchi M, Takami T. The Safety of Spine Surgery in the Late-Stage Elderly of 75 Years of Age or Older: A Retrospective Multicenter Study. World Neurosurg 2023; 172:e524-e531. [PMID: 36702243 DOI: 10.1016/j.wneu.2023.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this study was to verify that spine surgery for late-stage elderly (LSE) (age 65-74 years) is as safe as that for early-stage elderly (ESE) (age 65-74 years). METHODS This retrospective multicenter study included elderly patients aged ≥65 years who underwent spine surgery between 2018 and 2021. The medical information for individual patients was obtained from medical records. Activities of daily living (ADL) were estimated using a 5-grade scale based on the Eastern Cooperative Oncology Group performance status. Good outcome was defined as ADL grade 0 or 1 at discharge; poor outcome was defined as ADL grade 2 to 4 at discharge. The postoperative complications were listed with reference to the Common Terminology Criteria for Adverse Events v5.0. RESULTS There were 311 patients in the ESE group and 395 patients in the LSE group. Reoperation during hospitalization was significantly higher in the LSE group (4.6%) than in the ESE group (1.6%). The total number of days of hospitalization was significantly longer in the LSE group than in the ESE group. However, there was no significant difference in the postoperative complications or ADL at discharge between the 2 groups. In the statistical analysis, preoperative American Society of Anesthesiologists physical status class 3-6, underlying heart or renal disease, and cervical or thoracic spine level of surgical procedures were significantly associated with poor ADL outcomes at discharge. CONCLUSIONS Spine surgery even for LSE can be safely done, if perioperative risk factors are appropriately managed.
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Affiliation(s)
- Kosuke Sakai
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan; Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Masao Fukumura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Naoki Omura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shin-Ichi Miyatake
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Takahiro Fujishiro
- Department of Neurosurgery, Tanabe Neurosurgical Hospital, Fujiidera, Osaka, Japan
| | - Hideki Tanabe
- Department of Neurosurgery, Tanabe Neurosurgical Hospital, Fujiidera, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
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Kim HC, An SB, Jeon H, Kim TW, Oh JK, Shin DA, Yi S, Kim KN, Lee PH, Kang SY, Ha Y. Preoperative Cognitive Impairment as a Predictor of Postoperative Outcomes in Elderly Patients Undergoing Spinal Surgery for Degenerative Spinal Disease. J Clin Med 2021; 10:jcm10071385. [PMID: 33808297 PMCID: PMC8037175 DOI: 10.3390/jcm10071385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
Cognitive status has been reported to affect the peri-operative and post-operative outcomes of certain surgical procedures. This prospective study investigated the effect of preoperative cognitive impairment on the postoperative course of elderly patients (n = 122, >65 years), following spine surgery for degenerative spinal disease. Data on demographic characteristics, medical history, and blood analysis results were collected. Preoperative cognition was assessed using the mini-mental state examination, and patients were divided into three groups: normal cognition, mild cognitive impairment, and moderate-to-severe cognitive impairment. Discharge destinations (p = 0.014) and postoperative cardiopulmonary complications (p = 0.037) significantly differed based on the cognitive status. Operation time (p = 0.049), white blood cell count (p = 0.022), platelet count (p = 0.013), the mini-mental state examination score (p = 0.033), and the Beck Depression Inventory score (p = 0.041) were significantly associated with the length of hospital stay. Our investigation demonstrated that improved understanding of preoperative cognitive status may be helpful in surgical decision-making and postoperative care of elderly patients with degenerative spinal disease.
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Affiliation(s)
- Hyung Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Hyeongseok Jeon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Tae Woo Kim
- Department of Neurosurgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea;
| | - Jae Keun Oh
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
| | - Phil Hyu Lee
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Korea;
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Korea
- Correspondence: (S.Y.K.); (Y.H.)
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.C.K.); (S.B.A.); (H.J.); (D.A.S.); (S.Y.); (K.N.K.)
- Correspondence: (S.Y.K.); (Y.H.)
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