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Impact of Age on 30-day Complications After Adult Deformity Surgery
Kevin Phan1,2, Jun S Kim3, Sulaiman Somani3
1NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
Study Design:
A retrospective analysis.
Objective:
The aim of this study was to identify whether age is a risk factor for postoperative complications after adult deformity surgery (ADS).
Summary Of Background Data:
Spinal deformity is a prevalent cause of morbidity in the elderly population, occurring in as many as 68% of patients older than 60 years. Given the increasing prevalence of adult spinal deformities and an aging population, understanding the safety of ADS in elderly patients is becoming increasingly important.
Methods:
A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ADS were separated into age-based cohorts (≤52, 53-61, 62-69, and ≥70 years of age). Age groups were determined by interquartile analysis. Chi-squared, t tests, and multivariate logistic regression models were used to identify independent risk factors.
Results:
A total of 5805 patients met the inclusion criteria. Age groups 1, 2, 3, and 4 contained 1518 (26.1%), 1478 (25.4%), 1451 (25.0%), and 1358 (23.4%) patients, respectively. Multivariate logistic regression analysis revealed increasing age (relative to age group 1) to be an independent risk factor for prolonged length of stay [odds ratio (OR) 1.39, confidence interval (CI) 1.12-1.69], all complications (OR 1.64, CI 1.35-2.00), renal complications (OR 3.45, CI 1.43-8.33), urinary tract infection (OR 2.70, CI 1.49-4.76), postoperative transfusion (OR 1.47, CI 1.20-1.82), and unplanned readmission (OR 1.64, CI 1.18-2.23). Gradations in ORs existed between the different cohorts, such that the deleterious effect of age was less pronounced in cohort 3 compared with cohort 4, and even more less so between cohort 2 and cohort 4.
Conclusion:
Age has been shown to be an independent risk factor for increased length of stay, all complications, renal complications, urinary tract infection, transfusion, and unplanned readmission.
Level Of Evidence:
3.
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