title: Impact of Increasing Age on Outcomes of Spinal Fusion in Adult Idiopathic Scoliosis.
abstract: OBJECTIVE
  To investigate the role of advancing age on postoperative complications and revision surgery after fusion for scoliosis.
  
  
  METHODS
  A retrospective, cohort study was performed using the Thomson Reuters MarketScan database, examining patients with adult scoliosis who underwent spinal fusion from 2000 to 2009. Primary outcomes included infection, hemorrhage and pulmonary embolism (PE) within 90 days of surgery, and refusion. The effect of increasing age was estimated using the odds ratio (OR) of complications in a multivariate logistic regression analysis, and a Cox proportional hazard model estimated the hazard ratio of refusion.
  
  
  RESULTS
  A total of 8432 patients were included in this study. Overall, the average age was 53.3 years, with 26.90% males and 39% with a Charlson Comorbidity Score of ≥ 1. Most patients had commercial insurance (66.81%), with 26.03% and 7.16% covered by Medicare and Medicaid, respectively. Increasing age (per 5-year increment) was a significant predictor of hemorrhagic complication (OR, 1.06; confidence interval [CI], 1.01-1.11; P = 0.0196), PE (OR, 1.09; CI, 1.03-1.16; P = 0.0031), infection (OR, 1.04; CI, 1.01-1.07; P = 0.0053), and refusion (hazard ratio, 1.07; CI, 1.02-1.13; P = 0.0103).
  
  
  CONCLUSIONS
  In this study, age was associated with increased risk of hemorrhage, PE, infection, and refusion. With the aging population, the role of patient age on postoperative healing and outcomes deserves deeper investigation after repair of adult idiopathic scoliosis.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Toche
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: S Harrison
authors.initials: SH
authors.lastname: Farber
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Petraglia
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Murphy
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Parastou
authors.initials: P
authors.lastname: Fatemi
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Oren
authors.initials: O
authors.lastname: Gottfried
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: nandan.lad@dm.duke.edu.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Age; Outcomes; Scoliosis; Spinal fusion