Center for Spine Health, The Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA; Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
Center for Spine Health, The Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA; Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
Spine J. 2018 Sep;18(9):1603-1611. doi: 10.1016/j.spinee.2018.02.012. Epub 2018 Feb 14.
Degenerative changes in the cervical spine occur in an age-dependent manner. As the US population continues to age, the incidence of age-dependent, multilevel, degenerative cervical pathologies is expected to increase. Similarly, the average age of patients with cervical spondylotic myelopathy (CSM) will likely trend upward. Posterior cervical fusion (PCF) is often the treatment modality of choice in the management of multilevel cervical spine disease. Although outcomes following anterior cervical fusion for degenerative disease have been studied among older patients (aged 80 years and older), it is unknown if these results extend to octogenarian patients undergoing PCF for the surgical management of CSM.
The present study aimed to quantify surgical outcomes following PCF for the treatment of CSM among the octogenarian patient population compared with patients younger than 80 years old.
STUDY DESIGN/SETTING: This was a retrospective study that used the National Surgical Quality Improvement Program (NSQIP).
The sample included patients aged 60-89 who had CSM and who underwent PCF from 2012 to 2014.
The outcome measures were multimorbidity, prolonged length of stay (LOS), discharge disposition (to home or skilled nursing/rehabilitation facility), 30-day all-cause readmission, and 30-day reoperation.
The NSQIP database was queried for patients with CSM (International Classification of Disease, Ninth Revision, Clinical Modification code 721.1) aged 60-89 who underwent PCF (Current Procedural Terminology code 22600) from 2012 to 2014. Cohorts were defined by age group (60-69, 70-79, 80-89). Data were collected on gender, race, elective or emergent status, inpatientor outpatient status, where patients were admitted from (home vs. skilled nursing facility), American Society of Anesthesiologists class, comorbidities, and single- or multilevel fusion. After controllingfor these variables, logistic regression analysis was used to compare outcome measures in the different age groups.
A total of 819 patients with CSM who underwent PCF (416 aged 60-69, 320 aged 70-79, and 83 aged 80-89) were identified from 2012 to 2014. Of the PCF procedures, 79.7% were multilevel. There were no significant differences in the odds of multimorbidity, prolonged LOS, readmission, or reoperation when comparing octogenarian patients with CSM with patients aged 60-69 or 70-79. Patients aged 60-69 and 70-79 were significantly more likely to be discharged to home than patients over 80 (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8-10.4, p<.0001, and OR 2.7, 95% CI 1.1-6.4, p=.0005, respectively).
Compared with patients aged 60-69 and 70-79, octogenarian patients with CSM were significantly more likely to be discharged to a location other than home following PCF. After controlling for patient comorbidities and demographics, 80- to 89-year-old patients with CSM who underwent PCF did not differ in other outcomes when compared with the other age cohorts. These results can improve preoperative risk counseling and surgical decision-making.
颈椎的退行性改变呈年龄依赖性发生。随着美国人口老龄化的继续，与年龄相关的多节段退行性颈椎病变的发病率预计将会增加。同样，颈椎病脊髓病（CSM）患者的平均年龄也可能呈上升趋势。颈椎后路融合术（PCF）通常是治疗多节段颈椎疾病的首选方法。虽然已经研究了年龄在 80 岁及以上的老年患者行前路颈椎融合术治疗退行性疾病的结果，但尚不清楚这些结果是否适用于 80 岁以上接受 PCF 治疗 CSM 的 8 旬患者。
本研究旨在量化 80 岁以上老年患者行 PCF 治疗 CSM 的手术结果，并与年龄小于 80 岁的患者进行比较。
研究设计/设置：这是一项回顾性研究，使用了国家手术质量改进计划（NSQIP）数据库。
样本包括年龄在 60-89 岁之间、患有 CSM 并在 2012 年至 2014 年期间接受 PCF 的患者。
结局测量包括多种合并症、延长的住院时间（LOS）、出院去向（回家或康复护理/康复设施）、30 天全因再入院和 30 天再次手术。
从 2012 年至 2014 年，使用国家手术质量改进计划（NSQIP）数据库检索患有 CSM（国际疾病分类，第九修订版，临床修正码 721.1）并接受 PCF（当前操作术语代码 22600）的年龄在 60-89 岁的患者。队列按年龄组（60-69、70-79、80-89）进行定义。收集的数据包括性别、种族、择期或紧急状态、住院或门诊状态、患者入院来源（家或康复护理设施）、美国麻醉医师协会（ASA）分级、合并症以及单节段或多节段融合。在控制这些变量后，使用逻辑回归分析比较不同年龄组的结局测量。
2012 年至 2014 年间，共确定了 819 例接受 PCF 治疗的 CSM 患者（60-69 岁 416 例，70-79 岁 320 例，80-89 岁 83 例）。在接受 PCF 治疗的患者中，79.7%为多节段病变。与 60-69 岁或 70-79 岁的患者相比，80 岁以上的患者在多种合并症、延长 LOS、再入院或再次手术的几率方面没有显著差异。60-69 岁和 70-79 岁的患者与 80 岁以上的患者相比，出院回家的可能性显著更高（优势比[OR]4.3，95%置信区间[CI]1.8-10.4，p<.0001，和 OR 2.7，95%CI 1.1-6.4，p=.0005）。
与 60-69 岁和 70-79 岁的患者相比，80 岁以上的 CSM 患者在接受 PCF 治疗后，出院回家的可能性显著降低。在控制患者合并症和人口统计学特征后，与其他年龄组相比，接受 PCF 治疗的 80-89 岁 CSM 患者在其他结局方面没有差异。这些结果可以改善术前风险咨询和手术决策。
