Super-elderly, spinal surgery, evaluating the risks and benefits: a retrospective single-centre cohort study

Area of Science:

• Geriatric Medicine
• Neurosurgery
• Orthopedic Surgery

Background:

• The global population is aging, presenting unique challenges in healthcare, particularly for elderly patients requiring surgical interventions.
• Spinal surgery in super-elderly patients necessitates thorough clinical evaluation and understanding of factors influencing outcomes.

Purpose of the Study:

• To investigate the safety and outcomes of spinal surgery in patients aged 80 years and older.
• To assess the impact of spinal surgery on functional status using Clinical Frailty Scores (CFS).

Main Methods:

• Retrospective evaluation of patients aged 80+ undergoing elective or emergency spinal surgery (2017-2022).
• Classification of surgical procedures using the Eurospine Surgery Classification (ESC) into Large, Medium, and Small categories.
• Pre- and post-operative assessment and comparison of Clinical Frailty Scores (CFS).

Main Results:

• 245 patients (mean age 83.3) underwent spinal surgery, predominantly for degenerative conditions (82.0%) and classified as Minor surgery (82.0%).
• A significant portion (66.5%) were discharged or under follow-up, with an in-patient mortality rate of 4.5%.
• Clinical Frailty Scores (CFS) improved significantly from 5 pre-operatively to 4 post-operatively (p < 0.001).

Conclusions:

• Spinal surgery can be performed safely in patients over 80, leading to improvements in quality of life as indicated by CFS.
• Careful patient selection and comprehensive pre-operative assessment are crucial for successful outcomes in this age group.
• While patient selection is vital, emergency situations may necessitate surgery without extensive pre-operative evaluation.