Letter to the Editor. Perioperative complications in patients older than 80 years of age

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  • Neurosurgery of North Iowa, Mason City, IA
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TO THE EDITOR: I read with interest the article by Watanabe et al.1 (Watanabe T, Kanayama M, Takahata M, et al. Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study. J Neurosurg Spine. 2020;32[4]:622–630). The authors should be commended for attempting to reasonably answer the question of complication risks for our older patient population requiring spine surgery. My concern, however, is that the study as presented downplays the overall risk of surgery by including balloon kyphoplasty (BKP). The authors had 3 categories of complications: surgical site, major systemic, and minor systemic. Within the surgical category they also included instrumentation-specific and kyphoplasty-specific complications. My issue here is that including BKP with open surgery artificially decreases the overall complication rate by increasing the overall cohort of patients who are not going to have surgical site complications. Patients who undergo BKP are not going to have dural tears or surgical wound disruption because the percutaneous nature of the procedure does not really allow for it. In contrast, a surgical patient could have an instrumentation-specific and also a general surgical site complication. However, with the possible exception of hematoma and deep wound infection, none of the surgical complications the authors attempted to measure are really conceivable with BKP, so there were zero. The BKP minor systemic complications they described were also confusing: did they really have a case of anemia that required a transfusion? My overall point here is that they are lumping two different kinds of procedures together. I think the study would be better if the complications were described in the surgical groups alone.

Disclosures

Dr. Bhangoo has direct stock ownership in Branchpoint Technologies.

References

1

Watanabe T, Kanayama M, Takahata M, Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study. J Neurosurg Spine. 2020;32(4):622630.

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  • Hokkaido University, Sapporo City, Hokkaido, Japan
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Response

We appreciate the comments on our current article provided by Dr. Bhangoo. His major concern was underestimation of the risk in elderly patients with spine surgeries if BKP was included.

To defend against his criticism, we compared the complication rates whether or not BKP was included. As written in our article, overall complications developed in 54 of 270 patients (20.0%), surgical site complications in 22 of 270 (8.1%), and minor systemic complications in 40 of 270 (14.8%) when BKP was included. If BKP was excluded, overall complications developed in 51 of 238 (21.4%), surgical site complications in 21 of 238 (8.8%), and minor systemic complications in 38 of 238 (15.9%). As shown above, the complication rates were not substantially different whether or not BKP was included, and we reached the same conclusions in our article.

One of our goals was to clarify the safety of each surgical procedure in elderly patients. The complication rate of BKP in the elderly must be reported as written in this article; perioperative complications occurred in 3 of 32 BKPs (9.4%), which consisted of 1 surgical site complication (adjacent vertebral fracture) and 2 minor systemic complications (anemia and delirium). We believe this information will be beneficial to surgeons managing spine disorders in the elderly.

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Contributor Notes

Correspondence Sandeep S. Bhangoo: ssb794@neuroiowa.com.

INCLUDE WHEN CITING Published online June 12, 2020; DOI: 10.3171/2020.4.SPINE20510.

Disclosures Dr. Bhangoo has direct stock ownership in Branchpoint Technologies.

  • 1

    Watanabe T, Kanayama M, Takahata M, Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study. J Neurosurg Spine. 2020;32(4):622630.

    • Search Google Scholar
    • Export Citation

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