Study design:

A retrospective cohort study with chart review.

Objective:

To determine if there is a difference in risk of adverse outcomes following elective posterior instrumented lumbar spinal fusions for patients aged ≥80 compared to patients aged 50-79.

Summary of background data:

Patients aged ≥80 years are undergoing elective lumbar spinal fusion surgery in increasing numbers. There are conflicting data on the risks of intraoperative and postoperative complications in these patients.

Methods:

Patients aged ≥80 were compared to 50-79 (reference group) using time-dependent multivariable Cox-Proportional Hazards regression with a competing risk of death for longitudinal outcomes and multivariable logistic regression for binary outcomes. Outcome measures used were 1) intraoperative complications (durotomy), 2) postoperative complications: 30-day outcomes (pneumonia); 90-day outcomes (deep vein thrombosis [DVT], pulmonary embolism [PE], emergency room [ER] visits, readmission, reoperations, and mortality); and 2-year outcomes (reoperations and mortality).

Results:

The cohort consisted of 7,880 patients who underwent primary elective posterior instrumented lumbar spinal fusion (L1-S1) for degenerative disc disease or spondylolisthesis. This was subdivided into 596 patients were aged ≥80 and 7284 patients aged 50-79. After adjustment, patients aged ≥80 had a higher likelihood of durotomy (odds ratio [OR]=1.43, 95% confidence interval [CI]=1.02-2.02) and 30-day pneumonia (OR=1.81, 95% CI=1.01-3.23). However, there was a lower risk of reoperation within 2-years of the index procedure (hazard ratio [HR]=0.69, 95% CI=0.48-0.99). No differences were observed for mortality, readmissions, ER visits, PE, or DVT.

Conclusions:

In a cohort of 7,880 elective posterior instrumented lumbar fusion patients for degenerative disc disease or spondylolisthesis, we did not observe any significant risks of adverse events between patients aged ≥80 and those aged 50-79 except higher durotomies and 30-day pneumonia in the former. We believe octogenarians can safely undergo lumbar fusions, but proper preoperative screening is necessary to reduce the risks of 30-day pneumonia.