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Spine surgery is safe in older patients, study shows

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Degenerative spine diseases are a common health problem in older people, causing a gradual loss of normal function of the spine over time.

Surgery can improve quality of life — but is spine surgery advisable for older patients and what risks does it carry?

To find out, researchers from seven institutions in Japan conducted a multi-centre, prospective study of spine surgeries performed in patients 80 years of age and older.

The study included 270 patients aged 80+ who underwent elective spine surgery in 2017. Patients with tumours, infection or trauma were not included.

When assessing the outcomes, perioperative complications were defined as adverse events occurring during surgery or within the next 30 days. Complications were separated into those occurring at the surgical site and those that were systemic.

Findings published in the Journal of Neurosurgery: Spine show that the total perioperative complication rate was high, at 20% (67 complications in 54 patients), but there were no major systemic complications and no deaths.

Complications at the surgical site occurred in 22 patients (8.1%), and minor systemic complications (anaemia, delirium or urinary tract infection) occurred in 40 patients (14.8%). The rate of repeated operations was 4.1%.

To identify risk factors for perioperative complications, the authors examined surgical factors (operative level, number of spinal levels treated, type of surgery, length of surgery, and estimated blood loss) as well as patient demographics (age, sex, and body mass index) and preoperative health status.

Significant risk factors for minor systemic perioperative complications included spine surgery involving instrumentation (for example, inclusion of plates and screws); operations lasting more than 180 minutes; and the patient having a limited level of functioning in terms of their ability to care for themself and participate in daily activities.

Spine surgeons should be aware of these risk factors when preparing for surgery in this advanced-age patient group, the authors said.

Older age itself, the presence of comorbidities, and being at nutritional risk were not found to be risk factors.

Based on their findings, the authors concluded that it is safe to perform spine surgery in patients of advanced age.