European geriatric medicine · 2018
Is elective degenerative lumbar spine surgery in older adults safe in a short-stay clinic? Data from an institutional registry.
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Siccoli Alessandro, Staartjes Victor E, de Wispelaere Marlies P, Schröder Marc L
Аннотация
PURPOSE: Physicians are increasingly confronted with degenerative spinal pathologies and the possibility of elective surgical treatment in older adults. Little is known on safety and effectiveness of short-stay, elective lumbar spine surgery in this population. We aim to describe patient profiles of older adults undergoing surgery at a specialized short-stay clinic, and describe associated risk profiles and outcomes.
METHODS: From a prospective registry, patients older than 65 were compared to younger controls. All patients underwent a strict anesthesiologic screening preoperatively, leading to a carefully selected cohort of relatively robust older adults suited for safe treatment at a short-stay clinic. A range of perioperative data and reoperations were available from all patients, and a subgroup of patients completed outcome assessments for disability, pain, and health-related quality of life (HRQOL).
RESULTS: Of the 3279 included patients, 382 (12%) were older than 65. Older patients presented more often with spinal stenosis, and index levels were placed higher (p < 0.001). While there was no difference in complications, reoperations, and blood loss (p > 0.05), older people had longer surgical times and length of stay, although not by a clinically relevant margin (p < 0.001). Long-term patient-reported outcomes were equal (p > 0.05). However, older adults had worse 6-week outcomes for leg pain, functional disability, and HRQOL (all p < 0.05).
CONCLUSIONS: Higher age should not be considered a contraindication for elective lumbar spine surgery at short-stay clinics. If the anesthesiologic risk can be controlled, conservative treatments have failed, and muscle-sparing techniques are applied, favorable outcomes can be achieved with an acceptable risk profile in a safe manner.
METHODS: From a prospective registry, patients older than 65 were compared to younger controls. All patients underwent a strict anesthesiologic screening preoperatively, leading to a carefully selected cohort of relatively robust older adults suited for safe treatment at a short-stay clinic. A range of perioperative data and reoperations were available from all patients, and a subgroup of patients completed outcome assessments for disability, pain, and health-related quality of life (HRQOL).
RESULTS: Of the 3279 included patients, 382 (12%) were older than 65. Older patients presented more often with spinal stenosis, and index levels were placed higher (p < 0.001). While there was no difference in complications, reoperations, and blood loss (p > 0.05), older people had longer surgical times and length of stay, although not by a clinically relevant margin (p < 0.001). Long-term patient-reported outcomes were equal (p > 0.05). However, older adults had worse 6-week outcomes for leg pain, functional disability, and HRQOL (all p < 0.05).
CONCLUSIONS: Higher age should not be considered a contraindication for elective lumbar spine surgery at short-stay clinics. If the anesthesiologic risk can be controlled, conservative treatments have failed, and muscle-sparing techniques are applied, favorable outcomes can be achieved with an acceptable risk profile in a safe manner.