Mui Takahiro, Shigematsu Hideki, Ikejiri Masaki, Kawasaki Sachiko, Tanaka Yasuhito
Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan.
Asian Spine J. 2024 Dec;18(6):856-866. doi: 10.31616/asj.2024.0215. Epub 2024 Oct 22.
A retrospective comparative study.
To compare the characteristics of perioperative complications in patients aged ≥85 years with those of younger patients undergoing similar spine surgery and examine factors associated with perioperative complications and clinical outcomes among patients aged ≥85 years.
The risk factors for perioperative complications and their effect on outcomes in patients aged ≥85 years remain unclear. Furthermore, no study has compared younger patients with similar surgeries and condition with those aged ≥85 years.
The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75-84, and 65-74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications.
The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048).
Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.
一项回顾性比较研究。
比较85岁及以上患者与接受类似脊柱手术的年轻患者围手术期并发症的特征，并探讨85岁及以上患者围手术期并发症及临床结局的相关因素。
85岁及以上患者围手术期并发症的危险因素及其对结局的影响尚不清楚。此外，尚无研究将接受类似手术且病情相似的年轻患者与85岁及以上患者进行比较。
该研究纳入了接受脊柱手术的65岁及以上患者。年龄≥85岁、75 - 84岁和65 - 74岁的患者分别被分为超高龄组、老年组和准老年组。在三组患者手术方式和一般情况相匹配的情况下，比较围手术期与年龄相关并发症的差异（研究1）。此外，对超高龄组围手术期并发症的术前和术中因素进行研究（研究2）。并发症分为手术部位并发症和全身并发症。
每组分析44例患者。在研究1中，超高龄组、老年组和准老年组的总并发症发生率分别为40.9%、25%和18.2%。超高龄组和准老年组之间并发症发生率存在差异（p = 0.011）。在研究2中，分析了超高龄组的58例患者。手术部位并发症与手术时间延长（p = 0.02）和估计失血量增加（p = 0.003）显著相关。全身并发症与既往脑血管疾病（p = 0.014）、术前运动功能障碍（p = 0.023）和急诊病例（p = 0.006）显著相关，与糖尿病呈负相关（p = 0.048）。
超高龄组、老年组和准老年组围手术期并发症随年龄增长而增加。并发症类型与特定背景因素相关；因此，确定这些因素可能有助于预防围手术期并发症。
