Bang Chungwon, Kwon Kihyun, Ahn Joonghyun, Kim Young-Hoon
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Global Spine J. 2024 Nov 22:21925682241304332. doi: 10.1177/21925682241304332.
Retrospective cohort study.
Using propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.
We classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.
The clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, = 0.013), especially in delirium (34.69% vs 6.12%, = 0.001) than group E.
With the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.
回顾性队列研究。
采用倾向匹配评分法消除混杂偏倚，聚焦年龄因素，比较在一家三级医院接受治疗的韩国八旬老人队列中脊柱手术后的临床结局和围手术期并发症。
我们将80多岁的患者归类为八旬老人组（O组），65岁及以上且未满80岁的患者归类为老年组（E组）。我们策略性地采用倾向评分匹配（PSM）分析作为抵消潜在混杂变量的方法。对融合节段、估计失血量（EBL）、输血情况、体重指数（BMI）、美国麻醉医师协会（ASA）评分、查尔森合并症指数（CCI）、手术方法和手术时间进行1:1最近邻PSM。PSM后，每组均匀分配98例患者（O组，n = 49；E组，n = 49）。分析人口统计学、临床、放射学和术后并发症情况。
临床结局显示术前和术后视觉模拟评分（VAS）和日本骨科学会（JOA）评分无显著差异。并且大多数与住院相关的因素在两组之间无差异。然而，E组的随访期（1053.37 ± 684.14天）比O组（640.29 ± 496.68天，P = 0.001）长，且O组的医疗并发症发生率（38.77%对16.32%，P = 0.013）高于E组，尤其是谵妄发生率（34.69%对6.12%，P = 0.001）。
在做好术后谵妄防治准备的情况下，年龄本身不应成为脊柱手术犹豫的理由。
