2020 Volume 11 Issue 7 Pages 949-954
Introduction: In recent years, the number of spine surgeries performed in patients older than 90 years of age has been increasing. It has been reported that spine surgery in elderly patients confers high complication and mortality rates. Meanwhile, surgery may also be effective for elderly patients if the patient and procedure are selected appropriately. The purpose of this study was to determine the current status of spine surgery performed in patients older than 90 years of age in our department and to explore measures to reduce their complications.
Method: We retrospectively reviewed the medical records of 24 patients older than 90 years of age who underwent spine surgery between 2012 and 2018 (follow-up period of 3 months or more) and compared them with 1,022 patients in their 70s. For our analysis, we compared the surgical site, disease classification, American Society of Anesthesiologists physical status (ASA-PS), surgical procedure, operation time, blood loss, patient satisfaction, perioperative complications, hospitalization period, and sliding scale between the 2 groups. However, data of the complications, satisfaction, hospitalization period, and sliding scale were extracted from 24 consecutive patients during the same period in their 70s.
Results: No significant differences were noted in the surgical site and disease classification between patients in their 90s and 70s. Patients in their 90s underwent a greater number of balloon kyphoplasty procedures (BKPs) and less instrumentation than those in their 70s. Patients in their 90s experienced shorter operation times and less blood loss. Patients in their 90s accounted for a greater number of BKP cases; thus, we excluded BKP cases, except for those involving shorter operation times and less blood loss. More than 90% of the patients were satisfied based on the electronic medical record description. The complication rates were 20.8% (5/24) for patients in their 90s and 8.3% (2/24) for patients in their 70s, but there was no significant difference. The complications included delirium, heart failure, aspiration pneumonia, surgical site infections (SSIs) in patients in their 90s, and pulmonary embolus and SSIs in patients in their 70s. Patients in their 90s included one death case, but the overall hospitalization period was shorter among patients in their 90s than that among patients in their 70s. An ASA-PS score of 3 or higher was associated with many complications, especially among patients in their 90s. In cases of complications, there was a trend of patients exceeding the maximum value of Ishii's sliding scale, but the sliding scale was a necessary but insufficient condition for complications.
Conclusion: We found reduced complication rates due to shorter operation time and less blood loss among patients in their 90s. The ASA-PS is helpful for patient selection, and ASA-PS scores of 3 or more is associated with the occurrence of several complications. Spine surgery can be performed safely in patients older than 90 years of age if the patients are selected based on ASA-PS scores and surgical procedures are less invasive.
