Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, MI.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Spine (Phila Pa 1976). 2021 Mar 15;46(6):356-365. doi: 10.1097/BRS.0000000000003792.
Retrospective review of a multi-institutional data registry.
The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF).
Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain.
Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs.
A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50-69. A higher proportion of elderly experienced postoperative complications (P = .003) including urinary retention (P = <.001) and urinary tract infection (P = .002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (P = .001) and minor (P = .002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (P = <.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (P = <.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (P = <.001). Complications had no significant effect on PROs in the elderly.
Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.Level of Evidence: 3.
多机构数据注册的回顾性研究。
作者旨在确定在接受多节段经椎间孔腰椎融合术（MTLIF）的患者中，年龄与并发症和患者报告的结果（PRO）之间的关系。
接受 MTLIF 的老年患者被认为是高危人群。然而，缺乏关于并发症和 PRO 的数据。此外，老年人进行多节段腰椎融合术的安全性仍不确定。
分析了年龄≥50 岁、因退行性腰椎疾病接受 MTLIF 的患者。使用 MSSIC 数据库查询 90 天并发症和 PRO（基线、90 天、1 年、2 年）。PRO 通过背部和腿部视觉模拟量表（VAS）、患者报告的结果测量信息系统（PROMIS）、欧洲五维健康量表（EQ-5D）和北美脊柱协会（NASS）患者满意度指数进行测量。使用单变量分析比较老年组和并发症组。使用广义估计方程（GEE）确定并发症和 PRO 的预测因素。
共分析了 3120 例患者，其中 961 例（31%）≥70 岁，2159 例（69%）年龄在 50-69 岁之间。老年患者术后并发症发生率较高（P=0.003），包括尿潴留（P<.001）和尿路感染（P=0.002）。多变量分析表明，年龄与并发症无关。手术节段数与任何（P=0.001）和轻微（P=0.002）并发症相关。发生并发症与腿部 VAS 和 PROMIS 评分恶化独立相关（P<.001）。术前独立活动与 PROMIS 和 EQ5D 评分改善独立相关（P<.001）。在老年人中，术前独立活动和较低的 BMI 与 PROMIS 评分改善相关（P<.001）。并发症对老年人的 PRO 无显著影响。
年龄与 MTLIF 患者的并发症无关，也不能预测功能结果。因此，年龄本身可能不是风险的合适替代指标。此外，术前独立活动与更好的临床结果相关，应在术前手术咨询中考虑。
3 级。
