583 - Early Risk of Perioperative Adverse Events in Patients Older than 60 y...

#583 Early Risk of Perioperative Adverse Events in Patients Older than 60 years Old after Minimally Invasive Spine Surgery

MIS Techniques and Outcomes

Poster Presented by: R. Diaz

Author(s):

R. Diaz (1)
M.E. Berbeo (1)
R. Uribe (1)

(1) Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Neurosurgery, Bogota, Colombia

Abstract

Study Design: Retrospective case series.

Objective: The purpose of this study is to evaluate if there are any significant differences in risk of perioperative adverse events in adults aged 60 years or older after minimally invasive lumbar spine surgery when compared to younger patients.

Summary of Background Data: As population ages, the incidence of chronic diseases increases. Some of these diseases are clearly linked to a higher risk of morbidity and mortality especially in the early post operative period. Similarly, they are associated to an increased risk of complications in specific procedures like spine surgery where there are potentially higher rates of pseudarthrosis or infection. Minimally invasive spine surgery has been developed with the purpose of decreasing post operative pain, promoting accelerated recovery, decreasing hospital stay and operative blood loss. Potentially, one could argue that minimally invasive techniques could become a good alternative when treating older patients taking into account their advantages over the traditional more invasive procedures especially in the context of patients with previous comorbidities. To evaluate this hypothesis we took a sample of patients with lumbar degenerative disk disease treated with minimally invasive spine surgery and divided them into two groups according to age, using sixty years as the cutoff point. We then evaluated the risk of perioperative morbidity and mortality in the early post operative period (first thirty days) in both groups.

Materials and Methods: A retrospective sample of patients treated for lumbar degenerative disk disease using minimally invasive spine surgery techniques at a single university hospital from January 2007 to December 2012 was evaluated. Patients were categorized to one of two groups according to age, using 60 years as the cutoff point. Individual variables were collected to create a database. Statistical analysis was performed with specialized software (Stata V.12). A p-value less than 0.05 and 95% confidence intervals were used to calculate statistical significance. To evaluate for potential differences in comorbidities, a Chi-square test was used for categorical variables and Student´s T-test for cuantitative variables. Relative risk of post operative morbidity according to age was calculated using 95% confidence intervals. An adjusted relative risk was also calculated according to the presence of previous comorbidities.

Results: There was a statistically significant difference in terms of the increased presence of comorbidities in patients older than 60 years (p = 0.003). No differences in terms of hospital stay (p = 0.675) or estimated blood loss (p = 0.970) were found among both groups. Although the relative risk of suffering a postoperative adverse event was higher in patients older than 60 years (RR 1.7) the calculated confidence intervals were not statistically significant (0.71 - 3.94).

Conclusions: The present study showed no significant difference in the risk of perioperative morbidity among patients older than sixty years when compared to younger patients although there was a statistically significant difference regarding an increased presence of previous comorbidites in the group of patients older than sixty years. The results indicate that minimally invasive spine surgery doesn´t appear to have an increased risk of complications in older patients and therefore can be recommended as the treatment of choice for patients with previous significant comorbidities.