The Safety of Spinal Surgery in Patients over 80 Years of Age: Propensity Score Matching Study

Abstract

Study DesignRetrospective cohort study.ObjectivesUsing propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.MethodsWe classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.ResultsThe clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, P = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, P = 0.013), especially in delirium (34.69% vs 6.12%, P = 0.001) than group E.ConclusionsWith the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.

Keywords: octogenarian; postoperative complications; postoperative delirium; spinal surgery; super-aged society.

Figure 1.

Flow diagram for propensity score matching of studies.