Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany.
Neurosurg Rev. 2020 Apr;43(2):807-812. doi: 10.1007/s10143-019-01122-3. Epub 2019 Jun 1.
Demographic trends make it incumbent on spine surgeons to recognize the special challenges involved in caring for older patients. The aim of this study was to identify variables that may predict early mortality in geriatric patients over the age of 90 following elective hospitalization for various spinal pathologies. Retrospective analyses of all patients over the age of 90 years, which were electively treated between 2006 and 2016 at out department for various spinal conditions, were performed. Patient characteristics, type of treatment, and comorbidities were analyzed with regard to the 30-day mortality rate. Twenty-six patients were identified. Mean age was 93 years (range 91-97), 19 (73%) were female. Eighteen (69%) patients were treated operatively. Mean hospital stay was 13 days (range 2-51). Seventeen (65%) patients were on anticoagulation therapy. Mean Charlson Comorbidity Index (CCI) was 5.3 (range 1-11); mean diagnosis count (DC) was 8.3 (range 2-17); mean Geriatric Index of Comorbidity (GIC) was 2.8 (range 1-4); and mean comorbidity-polypharmacy score (GPS) was 13.3 (range 5-23). The 30-day mortality rate was 16.7% in the surgically treated group compared with 12.5% in the conservatively treated group (p = 0.9), anticoagulation therapy (p = 0.91), gender (p = 0.49), length of hospital stay (p = 0.33), GIC (p = 0.54), CCI (p = 0.74), GPS (p = 0.82), and DC (p = 0.65) did not correlate with the 30-day mortality rate. Cause of death was pulmonary embolism in two cases and unknown in one case. Thirty-day mortality rate in patients over 90 years old with degenerative spinal diseases is relatively high regardless of the treatment modality. Standard geriatric prognostic scores seem less reliable for these patients.
人口结构变化趋势使得脊柱外科医生有必要认识到，在为老年患者提供医疗服务时所面临的特殊挑战。本研究旨在确定 90 岁以上因各种脊柱病变择期住院的老年患者的相关变量，以预测其术后 30 天内的死亡率。对 2006 年至 2016 年期间因各种脊柱疾病在我科择期接受治疗的 90 岁以上患者进行回顾性分析。分析患者特征、治疗类型和合并症与 30 天死亡率的关系。共纳入 26 例患者，平均年龄为 93 岁（91-97 岁），19 例（73%）为女性。18 例（69%）患者接受手术治疗，平均住院时间为 13 天（2-51 天），17 例（65%）患者正在接受抗凝治疗。平均 Charlson 合并症指数（CCI）为 5.3（1-11 分）；平均诊断数量（DC）为 8.3（2-17 个）；平均老年合并症指数（GIC）为 2.8（1-4 分）；平均合并症-多药治疗评分（GPS）为 13.3（5-23 分）。手术治疗组的 30 天死亡率为 16.7%，而保守治疗组为 12.5%（p=0.9）；抗凝治疗（p=0.91）、性别（p=0.49）、住院时间（p=0.33）、GIC（p=0.54）、CCI（p=0.74）、GPS（p=0.82）和 DC（p=0.65）与 30 天死亡率均无相关性。死亡原因为肺栓塞 2 例，原因不明 1 例。无论治疗方式如何，90 岁以上退行性脊柱疾病患者的 30 天死亡率均相对较高。对于这些患者，标准老年预后评分的可靠性较差。
