Complications and Readmission After Cervical Spine Surgery in Elderly Patients: An Analysis of 1786 Patients

Abstract

Objective: To investigate risk factors and complications of cervical spine surgery in elderly patients.

Methods: A retrospective study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program. Patients ≥65 years old who underwent cervical spine surgery from 2005 to 2013 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and Current Procedural Terminology codes. Outcome data were classified as major complication, minor complication, readmission, or mortality.

Results: Of 1786 patients ≥65 years old undergoing cervical spine surgery identified, 175 (9.80%) patients experienced at least 1 complication or death. Patients ≥75 years old were at higher risk of developing a complication or death (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.13-2.61). Patients with increased operative times (OR 3.54, 95% CI 2.27-5.53), patients who were partially or totally dependent (OR 3.01, 95% CI 1.79-5.07), and patients listed as American Society of Anesthesiologists class III/IV/V (OR 1.87, 95% CI 1.20-2.94) had increased risks of perioperative complications. Patients 70-74 years old (OR 1.94, 95% CI 1.03-3.65) and patients with at least 1 postoperative complication (OR 9.59, 95% CI 5.17-17.80) had increased risks of unplanned readmissions. Patients ≥75 years old undergoing a laminectomy/laminotomy were at higher risk of complications (OR 3.20, 95% CI 1.33-7.70), whereas there was no difference in risk of complications based on age for elderly patients undergoing a fusion.

Conclusions: Patient comorbidities and clinical factors, such as longer operating time and emergency cases, impact risk of adverse events. Patients 70-74 years old and patients with at least 1 postoperative complication had an increased risk of unplanned readmission.

Keywords: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP); Cervical spine surgery; Complication; Geriatric; Readmission; Risk factors.