title: A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity.
abstract: BACKGROUND
  Recently, corrective fusion surgery for patients with adult spinal deformity (ASD) has become common in Japan. This study aimed to clarify the status of surgeries for ASD in Japan, focusing on perioperative complications. A nationwide multicenter survey gathering information on surgically treated ASD patients was conducted by the committee for Adult Spinal Deformity of the Japanese Scoliosis Society.
  
  
  METHODS
  This study was a review of retrospectively collected data from 18 spine scoliosis centers belonging to the Japanese Scoliosis Society. Patients who underwent corrective fusion surgery for ASD between 2011 and 2013 were included. Demographics, comorbidities, surgical data, and complications were investigated.
  
  
  RESULTS
  A total of 1192 patients (mean age, 57.7 years) were included in this study. Of these, 611 patients were aged less than 65 years and 581 patients were aged 65 years or greater. The age distribution had two peaks, in the third and eighth decades. Deformities caused by degeneration represented 67% of the pathology in patients aged over 65 years; however, non-degenerative disease such as adult idiopathic scoliosis and syndromic or congenital deformity represented over 60% of pathology in patients aged less than 65 years. The iatrogenic deformity and reoperation rates were both less than 3%. The mean operation time and estimated blood loss were 370 min and 1642 ml, respectively. Major perioperative complications occurred in 160 patients (14.5%). The incidence of complications was significantly higher in patients aged over 65 years, including neurological deficits, hemorrhagic shock, hematoma, heart failure, and surgical site infection (p < 0.05).
  
  
  CONCLUSIONS
  Older (aged over 65 years) ASD patients showed greater rates of deformity due to the occurrence of degeneration and vertebral fractures, as well as a higher incidence of peri-and postoperative complications. Efforts to reduce perioperative complications are therefore imperative, especially for elderly ASD patients in our aging society.
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu-shi 431-3192, Shizuoka, Japan. Electronic address: yamato@hama-med.ac.jp.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yamato
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu-shi 431-3192, Shizuoka, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Niigata Spine Surgery Center, Nishimachi 2-5-22, Konan-ku, Niigata-shi 950-0165, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Spinal Surgery, Yokohama Brain and Spine Center, Takigashira 1-2-1, Isogo-ku, Yokohama-shi 235-0012, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Aota
authors.affiliation: Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Ebaradai 2-36-2, Sakura-shi 285-8765, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Akazawa
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University Koshigaya Hospital, Minamikoshigaya 2-1-50, Koshigaya-shi 343-8555, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Sakaizekinishita 59-1, Hirosaki-shi 036-8076, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Ueyama
authors.affiliation: Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Nishiochiai 3-1-1, Suma-ku, Kobe-shi 654-0155, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Uno
authors.affiliation: Department of Orthopaedic Surgery, Konan Kosei Hospital, Takayacho Omatsubara 137, Konan-shi 483-8704, Japan.
authors.forename: Tokumi
authors.initials: T
authors.lastname: Kanemura
authors.affiliation: Department of Orthopaedic Surgery, Meijo Hospital, Sannomaru 1-3-1, Naka-ku, Nagoya-shi 460-0001, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Ebaradai 2-36-2, Sakura-shi 285-8765, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kotani
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara-shi 252-0375, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University, Asahi 3-1-1, Matsumoto-shi, 390-8621, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery, Okayama University Hospital, Shikatacho 2-5-1, Okayama-shi 700-8558, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibumachi, Shimotsuga-gun, 321-0207, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taneichi
authors.affiliation: Department of Orthopaedic Surgery, Meijo Hospital, Sannomaru 1-3-1, Naka-ku, Nagoya-shi 460-0001, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Noisshiki 4-6-1, Gifu-shi 500-8717, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.affiliation: Department of Orthopaedic Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi 259-1193, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Mochida
authors.affiliation: Department of Orthopaedic Surgery, Gunma Spine Center, Kamitoyookamachi 828-1, Takasaki-shi 370-0871, Japan.
authors.forename: Takachika
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University School of Medicine, Hongo 3-1-3, Bunkyou-ku, Tokyo 113-8431, Japan.
authors.forename: Ikuho
authors.initials: I
authors.lastname: Yonezawa
authors.affiliation: Department of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku-ku, 160-8582, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku-ku, 160-8582, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome