title: The Impact of Advanced Age on Peri-Operative Outcomes in the Surgical Treatment of Cervical Spondylotic Myelopathy: A Nationwide Study Between 2001 and 2010.
abstract: METHODS
  Retrospective multicenter database review.
  
  
  OBJECTIVE
  The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients.
  
  
  BACKGROUND
  Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients.
  
  
  METHODS
  A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]).
  
  
  RESULTS
  Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P < 0.0001), as was the total complications rate (11.39% vs. 5.93%, P < 0.0001) and charges ($57,449.94 vs. $49,951.11, P < 0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P < 0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P < 0.001) and courses (5.77 vs. 4.28 days, P < 0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P < 0.001), had increased total complications rate (13.87% vs. 10.20%, P < 0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P < 0.001), digestive system (1.92 [2.40-1.54], P < 0.001), and wound dehiscence (1.71 [2.56-1.15], P < 0.001).
  
  
  CONCLUSIONS
  Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.
authors: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
authors: Cyrus M
authors: CM
authors: Jalai
authors: Nancy
authors: N
authors: Worley
authors: Bryan J
authors: BJ
authors: Marascalchi
authors: Vincent
authors: V
authors: Challier
authors: Shaleen
authors: S
authors: Vira
authors: Sun
authors: S
authors: Yang
authors: Anthony J
authors: AJ
authors: Boniello
authors: John A
authors: JA
authors: Bendo
authors: Virginie
authors: V
authors: Lafage
authors: Peter G
authors: PG
authors: Passias
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D065406:Laminoplasty / Q000009:adverse effects / Q000639:trends; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000401:mortality / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000401:mortality / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000639:trends; D055009:Spondylosis / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology