title: Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients.
abstract: METHODS
  This is a retrospective cohort study using the National Inpatient Sample database.
  
  
  OBJECTIVE
  The objective is to report mortality and complications after lumbar laminectomy in the elderly.
  
  
  BACKGROUND
  As the population continues to age in the United States, it is important to consider the surgical complications and outcomes in the elderly. A review of the literature reveals controversy over the safety of lumbar laminectomy in the elderly and disagreement over estimates of risks in this population.
  
  
  METHODS
  Outcome measures were abstracted from the National Inpatient Sample. Multivariate analysis was performed to analyze the effect of patient and hospital characteristics on outcome measures.
  
  
  RESULTS
  A total of 471,215 patients underwent lumbar laminectomy without fusion for lumbar stenosis from 1993 to 2002. The in-hospital mortality rate was 0.17%, and the complication rate was 12.17%. Postoperative hemorrhage or hematoma (5.2%) and nonspecific renal complications (2.8%) were the most common complications. Complication and mortality rates increased with age and comorbidities with an 18.9% complication rate and 1.4% mortality rate in patients over the age of 85 with 3 or more comorbidities, 14.7% complication rate and 0.22% mortality rate in patients over 85 with no comorbidities, and only a 6% complication rate and 0.05% mortality rate in patient between 18 and 44 with no comorbidities. Multivariate analysis revealed increased odds of mortality with increasing number of comorbidities and complications in the greater than 85 year age group. Increasing age, number of comorbidities, complication rate, and female sex also increased the odds of discharge to institution other than home.
  
  
  CONCLUSIONS
  Elderly patients with comorbidities are at a higher risk for complications and adverse outcome after lumbar spine surgery. The effects of age and comorbidities on patient outcomes have been quantified. This information is critical in counseling elderly patients about the risk of surgery in their age group.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. gordonli@stanford.edu
authors.forename: Gordon
authors.initials: G
authors.lastname: Li
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Chris
authors.initials: C
authors.lastname: Ho
authors.forename: Wendy
authors.initials: W
authors.lastname: Tian
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome