title: Morbidity of Adult Spinal Deformity Surgery in Elderly Has Declined Over Time.
abstract: METHODS
  A retrospective review of a prospectively collected database, the Nationwide Inpatient Sample (NIS), years 2003 to 2012.
  
  
  OBJECTIVE
  The aim of this study was to examine trends in the management of scoliosis in elderly (age >75 yrs) patients from 2003 to 2012.
  
  
  BACKGROUND
  Scoliosis incidence rises with increasing age, and age has been shown to be an independent risk factor for surgical complications in scoliosis surgery. Previous studies have displayed increasing surgical frequency on elderly scoliotic patients in the last decade, but have not investigated complications in the same years.
  
  
  METHODS
  ICD-9 coding identified elderly (age ≥75 yrs) patients with a primary diagnosis of scoliosis undergoing lumbar fusion or decompression. Analysis of variance (ANOVA) comparisons and linear trend analysis described changes from 2003 to 2012 in surgical invasiveness (Mirza scale: levels fused/decompressed/instrumented and by approach), intraoperative complications, and Charlson Comorbidity Index (CCI). Secondary outcome measures included cost and discharge outcomes.
  
  
  RESULTS
  Eight thousand one elderly patients with ASD from 2003 to 2012 were included for analysis. Fusion incidence increased on average 13.8% per year (P < 0.001), surgical invasiveness by Mirza scale increased from 2.0 in 2003 to 5.9 in 2012 (P < 0.001), and CCI increased from 0.77 to 1.44 (p < 0.001). Over the same interval, elderly patients undergoing fusion displayed overall reduction in complications (excluding anemia)-from 26.7% to 8.6% (P < 0.001); specifically, surgical complications decreased from 11.7% to 0.7% (P < 0.001) and respiratory complications decreased from 6.7% to 1.4% (P = 0.004).
  
  
  CONCLUSIONS
  From 2003 to 2012, surgical management of ASD in the elderly population increased in incidence and complexity, while number of patient comorbidities increased and in-hospital morbidity decreased. This may indicate increased willingness of surgeon's to operate on elderly patients, and reflect a development of overall understanding of deformity in the past decade.
  
  
  METHODS
  3.
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Poorman
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Jalai
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD.
authors.forename: Brian
authors.initials: B
authors.lastname: Neuman
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD.
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Garza-Ramos
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD.
authors.forename: Emily
authors.initials: E
authors.lastname: Miller
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Johns Hopkins Medical Center, Baltimore, MD.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sciubba
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Louis
authors.initials: L
authors.lastname: Day
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Subaraman
authors.initials: S
authors.lastname: Ramchandran
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Vira
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Bassel
authors.initials: B
authors.lastname: Diebo
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Evan
authors.initials: E
authors.lastname: Isaacs
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Olivia
authors.initials: O
authors.lastname: Bono
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: NYU Medical Center-Hospital for Joint Diseases, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Gerling
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods