title: Complication rate during multilevel lumbar fusion in patients above 60 years.
abstract: BACKGROUND
  Spine surgery in elderly with comorbidities is reported to have higher complication rates and increased cost. However, the surgical outcome is good irrespective of the complications. Hence, it is essential to identify the factors affecting the complication rates in such patients and the measures to reduce them. This retrospective observational study determines the perioperative complications, their incidence and the measures to reduce complications in the elderly with comorbidities, operated by instrumented multilevel lumbar fusion.
  
  
  METHODS
  Patients aged 60 years and above with one or more comorbidities operated by multilevel instrumented lumbar fusion in our center between January 2012 and December 2013 were included in the study. Perioperative complications and their incidence were calculated. Age, number of levels fused, operative time, blood loss, and complication rates were correlated with the duration of stay and the incidence of perioperative complications using SPSS software. Measures to reduce complications are determined by these results and by review of literature.
  
  
  RESULTS
  Fifty two patients were included in the study (28 females and 24 males) with an average age of 69 years (range 60-84 years). Hypertension was the most common comorbidity followed by diabetes. Spondylolisthesis was the most common indication. Eleven complications were noted with an incidence of 21%. Three were systemic complications which required transfer to Intensive Care Unit. Local complications were incidental durotomy (three), transient root deficits (two), wound infections (one), and persistent radicular pain (two). Operative time and blood loss were significantly higher in patients with complications.
  
  
  CONCLUSIONS
  Complication rates strongly correlate with the blood loss and operative time. Reducing the operative time and blood loss by intraoperative tranexamic acid, laminectomy using osteotome, simultaneous bilateral exposure and instrumentation and reducing the number of interbody fusions can help in reducing the complications.
authors.affiliation: Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India.
authors.forename: Bijjawara
authors.initials: B
authors.lastname: Mahesh
authors.affiliation: Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India.
authors.forename: Bidre
authors.initials: B
authors.lastname: Upendra
authors.affiliation: Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Vijay
authors.affiliation: Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India.
authors.forename: Gc Arun
authors.initials: GA
authors.lastname: Kumar
authors.affiliation: Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Reddy
keywords: Comorbidities; Geriatrics; degenerative diseases; geriatrics; lumbar fusion; lumbar vertebrae; spinal fusion; spine; spondylolisthesis