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Risk Factors for the Development of Perioperative Complications in Elderly Patients Undergoing Lumbar Decompression and Arthrodesis for Spinal Stenosis: An Analysis of 166 Patients

Cassinelli, Ezequiel H. MD*; Eubanks, Jason MD*; Vogt, Molly PhD; Furey, Chris MD*; Yoo, Jung MD; Bohlman, Henry H. MD*

doi: 10.1097/01.brs.0000251918.19508.b3
Clinical Case Series

Study Design. Retrospective review.

Objective. To quantify and describe perioperative complication rates in a large series of well-matched elderly patients who underwent lumbar decompression and arthrodesis.

Summary of Background Data. Posterior lumbar decompression and fusion is frequently performed to treat lumbar stenosis with instability. An increasing number of elderly patients are undergoing operative treatment for degenerative lumbar disease. The reported morbidity of performing decompression and arthrodesis in this population varies widely in the literature, with recent reports showing a high rate of major complications.

Methods. A total of 166 patients age 65 or older that underwent primary posterior lumbar decompression and fusion with (group 1; n = 75) or without (group 2; n = 91) instrumentation were included. Hospital records were reviewed for the occurrence of any complications (major and minor), the need for transfusion, estimated length of stay, and disposition at discharge. Logistic regression (with the presence/absence of major complications as the dependent variable) was used to identify risk factors for the occurrence of a complication.

Results. Five major complications (3%) occurred (group 1, 1; group 2, 4). Minor complications developed in 30.7% of group 1 and 31.9% of group 2. There were no deaths, and only one perioperative complication was attributable to the use of instrumentation. Decompression/fusion of 4 or more segments was significantly associated with the occurrence of a major complication. Advanced age, the presence of medical comorbidities, or the use of instrumentation did not increase the rate of major or minor complications. The occurrence of either a major or minor complication prolonged hospital stay.

Conclusions. Posterior lumbar decompression and fusion can be safely performed in elderly patients, with a low rate of major complications. The addition of instrumentation does not increase the complication rate. These results differ from those previously reported in the literature, which describe a significantly higher rate of complications in this age group, with a prolonged rate of hospitalization.

Complication rates after decompression and arthrodesis in elderly patients vary in the literature, with recent reports showing a high rate of major complications. We found that these procedures can be safely performed, with a low rate of major complications. The addition of instrumentation does not increase the complication rate.

From the Department of Orthopaedic Surgery, *University Hospitals Spine Institute, Case School of Medicine, Cleveland OH; †University of Pittsburgh Medical Center, Pittsburgh, PA; and ‡Oregon Health Sciences University, Portland, OR.

Acknowledgment date: November 17, 2005. First revision date: February 14, 2006. Second revision date: March 29, 2006. Acceptance date: March 30, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Ezequiel H. Cassinelli, MD, 11100 Euclid Avenue, Cleveland, OH. 44106; E-mail: zekedr@hotmail.com

© 2007 Lippincott Williams & Wilkins, Inc.