title: Is spinal surgery safe in octogenarians?
abstract: BACKGROUND
  An ageing population and advances in medical management often requires spinal surgeons to increasingly operate on patients older than 80 years. The ability to predict complications and mortality rates would allow discrimination of which octogenarians are able to safely undergo spinal surgery. Therefore, the aims of this study were to determine whether comorbidities and extent of surgery were associated with complications in this age group, in addition to which comorbidity and physical status assessment scales were best associated with the development of complications following spinal surgery.
  
  
  METHODS
  A retrospective cohort study was performed. Comorbidities and physical health status were analysed using the American Society of Anesthesiologists (ASA) physical illness rating, Charlson Comorbidity Index (CCI) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score. Complications and extent of operation were sourced from patient records. The association between comorbidities/extent of operation and complications was analysed using negative binomial regression analysis.
  
  
  RESULTS
  A total of 54 patients were included in our study (22 elective and 32 emergency); 38 patients suffered at least one complication (14 elective and 24 emergency, including six deaths). Increased CIRS-G and CCI scores were associated with increased incidence of total complications in the elective cohort. Increased number of operated spinal levels was also associated with complications.
  
  
  CONCLUSIONS
  Elective spinal surgery can be safely performed in well selected patients over 80 years of age. However, extent of surgery, CIRS-G and CCI scores were associated with increased complications from spinal surgery in octogenarians.
authors.affiliation: The University of Melbourne Medical School, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Mihailidis
authors.affiliation: Department of Orthopaedics, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Manners
authors.affiliation: Statistics and Decision Analysis Platform, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Statistics and Decision Analysis Platform, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Gerald M Y
authors.initials: GMY
authors.lastname: Quan
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*
keywords: aged (over 80); neurosurgery; operative; orthopaedic surgery; postoperative complications; spinal; surgical