title: Lumbar spine surgery in patients 80 years of age or older: morbidity and mortality.
abstract: BACKGROUND
  The life expectancy increased significantly during last four decades and is associated with an increasing quality of life. The purpose of this study was to determine morbidity and mortality of degenerative lumbar spine surgery in patients 80 years of age or older.
  
  
  METHODS
  A consecutive retrospective review evaluated 121 consecutive patients, who had undergone posterior decompression associated or not with lumbar instrumentation. The average age at the time of surgery was 83.2 ± 2.4 years. The study analyzed the comorbidities, the operative procedure and postoperative morbidity and mortality.
  
  
  RESULTS
  Blood loss increased significantly with instrumentation (538 vs. 280 mL, p < 0.0001). The average operative time was 103 ± 38 min and increased significantly with instrumentation (131.2 vs. 84 min, p = 0.003), blood loss (p < 0.0001) and dural tears (p = 0.05). Dural tears occurred in 19 patients (15.7%) and were associated significantly with previous lumbar surgery (33.3 vs. 12.4%, p = 0.017) and major complications (30 vs. 9.9%, p = 0.01). Major complications occurred in 16 patients (13%). Minor complications occurred in 36 patients (29.7%). The delirium was associated with instrumentation (22 vs. 7%, p = 0.017) and blood loss (520 vs. 348 mL, p = 0.034). The average hospital stay was 11.3 ± 8.1 days. No patients died after a postoperative period of 1 year. The average follow-up was 24.3 ± 16.5 months.
  
  
  CONCLUSIONS
  The morbidity of degenerative lumbar spine surgery in patients 80 years of age or older was high. Blood loss, operative time, instrumentation, previous surgery and dural tears increased significantly the morbidity. This surgery must be decided very carefully and requires to inform the patient and his family of the high rate of complications.
authors.affiliation: Department of Orthopaedics, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France, laurent.balabaud@imm.fr.
authors.forename: L
authors.initials: L
authors.lastname: Balabaud
authors.forename: S
authors.initials: S
authors.lastname: Pitel
authors.forename: I
authors.initials: I
authors.lastname: Caux
authors.forename: C
authors.initials: C
authors.lastname: Dova
authors.forename: B
authors.initials: B
authors.lastname: Richard
authors.forename: P
authors.initials: P
authors.lastname: Antonietti
authors.forename: C
authors.initials: C
authors.lastname: Mazel
mesh_terms: D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015897:Comorbidity; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D003693:Delirium / Q000209:etiology; D004388:Dura Mater / Q000293:injuries; D004824:Epidural Space; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D061646:Operative Time; D011542:Pseudarthrosis / Q000209:etiology; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D013530:Surgical Wound Infection / Q000209:etiology; D017211:Treatment Failure; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology