Impact of Age on 30-day Complications After Adult Deformity Surgery.

STUDY DESIGN

A retrospective analysis.

OBJECTIVE

The aim of this study was to identify whether age is a risk factor for postoperative complications after adult deformity surgery (ADS).

SUMMARY OF BACKGROUND DATA

Spinal deformity is a prevalent cause of morbidity in the elderly population, occurring in as many as 68% of patients older than 60 years. Given the increasing prevalence of adult spinal deformities and an aging population, understanding the safety of ADS in elderly patients is becoming increasingly important.

METHODS

A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ADS were separated into age-based cohorts (≤52, 53-61, 62-69, and ≥70 years of age). Age groups were determined by interquartile analysis. Chi-squared, t tests, and multivariate logistic regression models were used to identify independent risk factors.

RESULTS

A total of 5805 patients met the inclusion criteria. Age groups 1, 2, 3, and 4 contained 1518 (26.1%), 1478 (25.4%), 1451 (25.0%), and 1358 (23.4%) patients, respectively. Multivariate logistic regression analysis revealed increasing age (relative to age group 1) to be an independent risk factor for prolonged length of stay [odds ratio (OR) 1.39, confidence interval (CI) 1.12-1.69], all complications (OR 1.64, CI 1.35-2.00), renal complications (OR 3.45, CI 1.43-8.33), urinary tract infection (OR 2.70, CI 1.49-4.76), postoperative transfusion (OR 1.47, CI 1.20-1.82), and unplanned readmission (OR 1.64, CI 1.18-2.23). Gradations in ORs existed between the different cohorts, such that the deleterious effect of age was less pronounced in cohort 3 compared with cohort 4, and even more less so between cohort 2 and cohort 4.

CONCLUSION

Age has been shown to be an independent risk factor for increased length of stay, all complications, renal complications, urinary tract infection, transfusion, and unplanned readmission.

LEVEL OF EVIDENCE