title: Increased risk of complications after anterior cervical discectomy and fusion in the elderly: an analysis of 6253 patients in the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: METHODS
  Retrospective cohort analysis of anterior cervical discectomy and fusion (ACDF) surgical procedures using a prospectively collected database.
  
  
  OBJECTIVE
  To characterize the 30-day postoperative outcomes in elderly patients undergoing ACDF after adjustment for comorbidities using a multi-institutional database.
  
  
  BACKGROUND
  Prior studies on the effect of age after ACDF have mostly focused on in-hospital complications, have come from single institutions, or have included ACDF in pooled analyses and have not distinctly analyzed the specific complications associated with age after ACDF.
  
  
  METHODS
  Patients undergoing ACDF were selected in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Patients were stratified into 4 age-groups: 18 to 39 years, 40 to 64 years, 65 to 74 years, and 75 years or more (based on standard deviation cohorts). Patients in the different age categories were compared using the χ statistic, the Fisher exact test, and analysis of variance. Multivariate linear/logistic regression models were used to adjust for preoperative comorbidities. Significance was defined as P < 0.05.
  
  
  RESULTS
  Data were available for 6253 patients who underwent ACDF. On multivariate logistic regression, both groups of elderly patients (65-74 and ≥75 yr) were more likely to have blood transfusions, reoperations, urinary complications, extended length of stays, and 1 or more complication, overall. Only patients 65 to 74 years were more likely to have a pulmonary embolism/deep vein thrombosis, whereas only patients aged 75 years or older were more likely to experience respiratory complications, central nervous system complications, or death. There were no differences in complication rates between the 18- to 39-year age-group and 40- to 64-year age-group. The 18- to 39-year age-group and 75-year age-group had shorter operating room times.
  
  
  CONCLUSIONS
  Older age is an independent risk factor for greater morbidity and longer hospitalizations after ACDF, even after adjustment for comorbidities when compared with younger patients. Surgeons should be aware of the increased risk of multiple complications for patients of advanced age in their surgical decision making.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT; and †Columbia University Medical Center, New York, NY.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Buerba
authors.forename: Erica
authors.initials: E
authors.lastname: Giles
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Webb
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fu
authors.forename: Borys
authors.initials: B
authors.lastname: Gvozdyev
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult