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Can Elective Spine Surgery Be Performed Safely Among Nonagenarians?

Analysis of a National Inpatient Database in Japan

Oichi, Takeshi, MD; Oshima, Yasushi, MD, PhD; Matsui, Hiroki, MPH; Fushimi, Kiyohide, MD, PhD; Tanaka, Sakae, MD, PhD; Yasunaga, Hideo, MD, PhD

doi: 10.1097/BRS.0000000000002842

Study Design. Retrospective cohort study.

Objective. To compare morbidity and mortality between nonagenarians and other older adult patients who underwent elective spine surgery.

Summary of Background Data. There is a lack of information of the perioperative risks of nonagenarians undergoing spine surgery.

Methods. Data of patients aged ≥65 years who underwent elective spine surgery from July 2010 to March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. Clinical outcomes included mortality, occurrence of major complications (cardiac events, respiratory complications, pulmonary embolism, stroke, and acute renal failure), urinary tract infection, and postoperative delirium. These clinical outcomes in nonagenarians were compared with those in patients aged 65 to 79 years and octogenarians. A multivariate logistic regression model fitted with a generalized estimation equation was used to evaluate the influence of advanced age on 90-day mortality and postoperative major complications.

Results. Of 88,370 patients identified in the database, 418 were nonagenarians. Compared with patients aged 65 to 79 years and octogenarians, nonagenarians had the highest rates of 90-day mortality (0.2%, 0.3%, and 1.7%, respectively; P < 0.001) and at least one major complication (3.7%, 5.0%, and 7.4%, respectively; P < 0.001). Nonagenarians had the highest proportions of cardiac events, respiratory complications, urinary tract infections, and delirium. The multivariable logistic regression analyses revealed that nonagenarians had increased risks of both 90-day mortality (odds ratio, 8.65; 95% confidence interval, 3.62–20.6) and postoperative major complications (odds ratio, 2.32; 95% confidence interval, 1.61–3.36) compared with patients aged 65 to 79 years.

Conclusion. Nonagenarians had increased morbidity and mortality following elective spine surgery compared with other older adult patients. Among the complications, cardiac events, respiratory complications, urinary tract infection, and delirium were more likely to occur in nonagenarians.

Level of Evidence: 3

Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

Address correspondence and reprint requests to Yasushi Oshima, MD, PhD, Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; E-mail:

Received 23 March, 2018

Revised 15 June, 2018

Accepted 24 July, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Ministry of Health, Labour and Welfare, Japan (H29-Policy-Designated-009 and H29-ICT-Genral-004); Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141); and the Japan Agency for Medical Research and Development (15lk1110001h0001) grant funds were received in support of this work.

No relevant financial activities outside the submitted work.

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