286 - Morbidity of Adult Spinal Deformity Surgery in Elderly Has Declined Ov...

Oral Posters: Adult Spinal Deformity

Presented by: A. Sure - View Audio/Video Presentation (Members Only)

Author(s):

P. Passias(1), G. Poorman(1), C. Jalai(1), B. Neuman(2), R. de la Garza-Ramos(2), E. Miller(2), A. Jain(2), D. Sciubba(2), S. McClelland(1), L. Day(1), S. Ramchandran(1), S. Vira(1), B. Diebo(3), S. Horn(1), A. Sure(1), J. Tishelman(1), E. Isaacs(1), O. Bono(1), S. Bess(4), M. Gerling(1), V. Lafage(5)

(1) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(2) Johns Hopkins University School of Medicine, Neurosurgery, Baltimore, MD, United States
(3) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(4) Denver International Spine Center, Denver, CO, United States
(5) Hospital for Special Surgery, New York, NY, United States

Abstract

Study Design: Retrospective review of a prospectively collected database, the Nationwide Inpatient Sample (NIS), years 2003-2012.

Objectives: To examine trends in the management of scoliosis in elderly (age>75) patients from 2003-2012.

Summary of Background Data: Scoliosis incidence rises with increasing age, and age has been shown to be an independent risk factor for surgical complications in scoliosis surgery. Previous studies have displayed increasing surgical frequency on elderly scoliotic patients in the last decade, but have not investigated complications in the same years.

Methods: ICD-9 coding identified elderly (age ≥75) patients with a primary diagnosis of scoliosis undergoing lumbar fusion or decompression. ANOVA comparisons and linear trend analysis described changes from 2003-12 in surgical invasiveness (Mirza´s scale: levels fused/decompressed/instrumented and by approach), intra-operative complications, and Charlson Comorbidity Index (CCI). Secondary outcome measures included cost and discharge outcomes.

Results: 8,001 elderly patients with ASD from 2003-2012 were included for analysis. Fusion incidence increased on average 13.8% per year (p< 0.001), surgical invasiveness by Mirza's scale increased from 2.0 in 2003 to 5.9 in 2012 (p< 0.001), and CCI increased from 0.77 to 1.44 (p< 0.001). Over the same interval, elderly patients undergoing fusion displayed overall reduction in complications (excluding anemia) - from 26.7% to 8.6% (p< 0.001); specifically, surgical complications decreased from 11.7% to 0.7% (p< 0.001) and respiratory complications decreased from 6.7% to 1.4% (p=0.004).

Conclusion: From 2003-12 surgical management of ASD in the elderly population increased in incidence and complexity, while number of patient comorbidities increased and in-hospital morbidity decreased. This may indicate increased willingness of surgeon's to operate on elderly patients, and reflect a development of overall understanding of deformity in the past decade. Levels of Evidence: III