title: Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge.
abstract: OBJECTIVE With improving medical therapies for chronic conditions, elderly patients increasingly present as candidates for operative intervention for degenerative diseases of the spine. To date, there is a paucity of studies examining complications in lumbar decompression, without fusion, that include patients older than 80 years. Using a multicenter national database, the authors of this study evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes. METHODS The 2011-2013 American College of Surgeons' National Surgical Quality Improvement Program data set was queried for patients 65 years and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion. Morbidity and mortality within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission within 30 days or discharge to a nonhome facility. Outcomes and operative characteristics were compared using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression models. RESULTS A total of 8744 patients were identified; of these patients 4573 (52.30%) were 65 years and older. Elderly patients were stratified into 3 age categories: 85 years or older (n = 314), 75-84 years (n = 1663), and 65-74 years (n = 2596). Univariate analysis showed that, compared with age younger than 65 years, increased age was associated with the number of levels (≥ 3), readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion (all p < 0.001). On multivariable analysis and with younger than 65 years as the reference, increased age was associated with any minor complication (p < 0.001; ≥ 85 years: OR 3.47, 95% CI 1.69-7.13; 75-84 years: OR 2.34, 95% CI 1.45-3.78; and 65-74 years: OR 1.44, 95% CI 0.94-2.20), as well as discharge location other than home (p < 0.001; ≥ 85 years: OR 13.59, 95% CI 9.47-19.49; 75-84 years: OR 5.64, 95% CI 4.33-7.34; and 65-74 years: OR 2.61, 95% CI 2.05-3.32). CONCLUSIONS The authors' high-powered, multicenter analysis of lumbar decompression without fusion in the elderly, specifically including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Murphy
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gilder
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Maloney
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rinaldo
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepherd
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kerezoudis
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ubl
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.
authors.forename: William E
authors.initials: WE
authors.lastname: Krauss
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic.|Mayo Clinic Neuro-Informatics Laboratory; and.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications; D011184:Postoperative Period; D058996:Quality Improvement; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods
keywords: ACS-NSQIP = American College of Surgeons' National Surgical Quality Improvement Program; ASA = American Society of Anesthesiologists; BMI = body mass index; BUN = blood urea nitrogen; CHF = congestive heart failure; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; CPT = Current Procedural Terminology; DVT = deep vein thrombosis; GFR = glomular filtration rate; INR = international normalized ratio; IQR = interquartile range; NSQIP; SSI = surgical site infection; UTI = urinary tract infection; degenerative spine disease; eGFR = estimated GFR; elderly; lumbar decompression; postoperative complications