The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases

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OBJECTIVE

Three-column osteotomies are increasingly being used in the elderly population to correct rigid spinal deformities. There is hesitation, however, in performing the technique in older patients because of the high risk for blood loss, longer operative times, and complications. This study assesses whether age alone is an independent risk factor for complications and length of stay.

METHODS

All patients with thoracolumbar adult spinal deformity (ASD) who underwent 3-column osteotomy (vertebral column resection or pedicle subtraction osteotomy) performed by the senior author from 2006 to 2016 were identified. Demographics, clinical baseline, and surgical details were collected. Outcomes of interest included perioperative complication, ICU stay, and hospital stay. Bivariate and multivariate analyses were used to assess the association of age with outcomes of interest.

RESULTS

A total of 300 patients were included, and 38.3% were male. The mean age was 63.7 years: 10.3% of patients were younger than 50 years, 36.0% were 50–64 years, 45.7% were 65–79 years, and 8.0% were 80 years or older. The overall mean EBL was 1999 ml. The overall perioperative complication rate was 24.7%: 18.0% had a medical complication and 7.0% had a surgical complication. There were no perioperative or 30-day deaths. Age was associated with overall complications (p = 0.002) and medical-specific complications (p < 0.001); there were higher rates of overall and medical complications with increased age: 9.7% and 6.5%, respectively, for patients younger than 50 years; 16.7% and 10.2%, respectively, for patients 50–64 years; 31.4% and 22.6%, respectively, for patients 65–79 years; and 41.7% and 41.7%, respectively, for patients 80 years or older. However, after adjusting for relevant covariates on multivariate analysis, age was not an independent factor for perioperative complications. Surgical complication rates were similar among the 4 age groups. Longer ICU and total hospital stays were observed in older age groups, and age was an independent factor associated with longer ICU stay (p = 0.028) and total hospital stay (p = 0.003). ICU stays among the 4 age groups were 1.6, 2.3, 2.0, and 3.2 days for patients younger than 50 years, 50–64 years, 65–79 years, and 80 years or older, respectively. The total hospital stays stratified by age were 7.3, 7.7, 8.2, and 11.0 days for patients younger than 50 years, 50–64 years, 65–79 years, and 80 years or older, respectively.

CONCLUSIONS

Older age was associated with higher perioperative complication rates, but age alone was not an independent risk factor for complications following the 3-column osteotomy for ASD. Comorbidities and other unknown variables that come with age are likely what put these patients at higher risk for complications. Older age, however, is independently associated with longer ICU and hospital stays.

ABBREVIATIONS ASD = adult spinal deformity; EBL = estimated blood loss; HRQLS = health-related quality of life score; LL = lumbar lordosis; PI = pelvic incidence; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; SVA = sagittal vertical axis; VCR = vertebral column resection.

Article Information

Correspondence Christopher P. Ames: University of California, San Francisco, CA. amesc@neurosurg.ucsf.edu.

INCLUDE WHEN CITING Published online April 6, 2018; DOI: 10.3171/2017.10.SPINE17374.

Disclosures Dr. Deviren: consultant for NuVasive, Guidepoint, and Medicrea; and spine fellowship grant support to the institution from Globus, NuVasive, and AOSpine. Dr. Ames: employee of UCSF; consultant for Stryker, Medtronic, and DePuy; patent holder with Fish & Richardson, PC; and royalties from Biomet Spine and Stryker.

© AANS, except where prohibited by US copyright law.

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    Images obtained in a 85-year-old patient who presented with a several-year history of severe, debilitating low-back pain on walking and standing with a forward-stooping posture. He had been very active, but his back pain and posture made his quality of life intolerable. The patient underwent L-3 PSO and long segment fusion for correction of his thoracolumbar kyphoscoliosis. A and B: Preoperative lateral (A) and anteroposterior (B) standing radiographs. The preoperative sagittal spinopelvic parameters were as follows: SVA, 17.1 cm; thoracic kyphosis, 14°; LL, −6°; and PI, 58°. The PI-LL mismatch was 64°. The preoperative central sacral vertical line (CSVL) was 7.8 cm to the right, and 27° of scoliosis was present. C and D: Postoperative lateral (C) and anteroposterior (D) standing radiographs. The postoperative sagittal spinopelvic parameters were as follows: SVA, 1.1 cm; thoracic kyphosis, 44°; LL, 42°; and PI, 50°. After correction, LL and PI were within 8°. The postoperative CSVL was 0.8 cm to the right, and 11° of scoliosis was present.

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