Is Eighty the New Sixty? Outcomes and Complications after Lumbar Decompression Surgery in Elderly Patients over 80 Years of Age

Autor: Julia Gerhardt, Yu-Mi Ryang, Stefanie Bette, Bernhard Meyer, Insa Janssen, Jens Gempt
Rok vydání: 2018
Předmět:
musculoskeletal diseases
Postoperative Complications/epidemiology
Male
medicine.medical_specialty
Decompression
Lumbar Vertebrae/surgery
Urinary system
Population
law.invention
03 medical and health sciences
Postoperative Complications
Spinal Stenosis
0302 clinical medicine
Lumbar
law
Intervertebral Disc Displacement/surgery
Humans
Medicine
Postoperative Period
030212 general & internal medicine
education
Retrospective Studies
Aged
80 and over
education.field_of_study
Lumbar Vertebrae
business.industry
Incidence
Incidence (epidemiology)
Age Factors
Lumbar spinal stenosis
Decompression
Surgical
medicine.disease
Intensive care unit
Surgery
Treatment Outcome
Spinal Stenosis/surgery
Female
Neurology (clinical)
Diskectomy/adverse effects/methods
business
Complication
Decompression
Surgical/adverse effects/methods
Intervertebral Disc Displacement
030217 neurology & neurosurgery
Diskectomy
Zdroj: World Neurosurgery, Vol. 112 (2018) pp. e555-e560
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2018.01.082
Popis: Objective An increasing demographic aging of the general population results in a rising incidence of octogenarians and nonagenarians with spine disease. Patients older than 65 years represent the majority of patients with degenerative lumbar spine disease in our daily clinical routine. Surgical treatment is undertaken reluctantly because of an increased rate of comorbidities. We therefore assessed complication rates of lumbar decompression in regard to neurological outcome and medical conditions in patients age 80 years or older in a retrospective single-center series. Methods Data for 244 patients (124 female, 120 male; mean age, 83.1 ± 3 years; age range, 80–95 years) who underwent decompressive surgery for lumbar spinal stenosis or disc herniation between April 2007 and February 2016 were assessed retrospectively. Age at surgery, neurologic deficits (preoperative and postoperative), relevant medical comorbidities and previous lumbar decompression, intraoperative and postoperative complications (e.g., surgery-related, medical), duration of surgery, length of hospital stay, and rate of revision surgeries were recorded. Results Surgery was performed for lumbar stenosis (184 patients; 75.4%), lumbar disc herniation (13 patients; 5.3%) or both (47 patients; 19.3%). Seventy-six patients (31.3%) patients experienced preoperative neurologic deficits; 48 (63.2%) of these patients improved, 28 (36.8%) of them were unchanged after surgery, and none deteriorated. New transient, postoperative, neurologic deficits occurred in 6 patients (2.5%). All 55 (22.5%) intraoperative complications were mild to moderate, and no severe surgical complications occurred. Two hundred fifteen patients (88%) had relevant medical disorders. Nineteen (7.7%) postoperative medical complications were reported in 17 patients (7%), of which 14 (73.7%) were severe and 5 (26.3%) were mild (4 pulmonary embolisms, 6 pneumonias, 3 myocardial infarctions, 1 postoperative renal failure, 5 urinary tract infections). Medical complications that necessitated intensive care unit treatment and resulted in lethal outcome were seen in 2 patients (0.8%). Conclusion Despite their age, the vast majority of octogenarians and nonagenarians benefited from lumbar decompression surgery. Mild to moderate intraoperative complications were relatively frequent, whereas severe intraoperative complications did not occur. The majority of medical complications was severe, but the incidence was acceptable, and the postoperative outcome was still favorable in most patients.
Databáze: OpenAIRE
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