This is a multicentered retrospective study.
Summary of Background Data:
Surgical correction for the adult spinal deformity
(ASD) is effective but carries substantial risks for complications
. The diverse pathologies of ASD make it difficult to determine the effect of advanced age
The objective of this study was to assess how advanced age
affects outcomes and cost-effectiveness for corrective surgery for ASD.
Materials and Methods:
We used data from a multicenter database to conduct propensity score–matched comparisons of 50 patients who were surgically treated for ASD when at least 50 years old and were followed for at least 2 years, to clarify whether advanced age
is a risk factor for inferior health-related quality of life and cost-effectiveness. Patients were grouped by age
, 50–65 years (M group: 59±4 y) or >70 years (O group: 74±3 y), and were propensity score–matched for sex, body mass index, upper and lower instrumented vertebrae, the use of pedicle-subtraction osteotomy, and sagittal alignment. Cost-effectiveness was determined by cost/quality-adjusted life years.
Oswestry Disability Index and Scoliosis Research Society-22 (SRS-22) pain and self-image at the 2-year follow-up were significantly inferior in the O group (Oswestry Disability Index: 32±9% vs. 25±13%, P
=0.01; SRS-22 pain: 3.5±0.7 vs. 3.9±0.6, P
=0.05; SRS-22 self-image: 3.5±0.6 vs. 3.8±0.9, P
=0.03). The O group had more complications
than the M group (55% vs. 29%). The odds ratios in the O group were 4.0 for postoperative complications
(95% confidence interval: 1.1–12.3) and 4.9 for implant-related complications
(95% confidence interval: 1.2–21.1). Cost-utility analysis at 2 years after surgery indicated that the surgery was less cost-effective in the O group (cost/quality-adjusted life year: O group: $211,636 vs. M group: 125,887, P
Outcomes for corrective surgery for ASD were inferior in geriatric patients compared with middle-aged patients, in whom the extent of spinal deformity and the operation type were adjusted similarly. Special attention is needed when considering surgical treatment for geriatric ASD patients.