title: Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis.
  
  
  BACKGROUND
  Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis.
  
  
  METHODS
  Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality.
  
  
  RESULTS
  There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p=0.016) than in the NM group.
  
  
  CONCLUSIONS
  Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery.
authors: Department of Spine, Wockhardt Hospital, South Mumbai, Mumbai, India.
authors: Manish Kundanmal
authors: MK
authors: Kothari
authors: Department of Spine, Wockhardt Hospital, South Mumbai, Mumbai, India.
authors: Kunal Chandrakant
authors: KC
authors: Shah
authors: Department of Spine, Wockhardt Hospital, South Mumbai, Mumbai, India.
authors: Agnivesh
authors: A
authors: Tikoo
authors: Department of Spine, Wockhardt Hospital, South Mumbai, Mumbai, India.
authors: Abhay Madhusudan
authors: AM
authors: Nene
keywords: Elderly; Mortality; Risk factors; Spinal tuberculosis; Surgery