Bovonratwet Patawut, Holly Kaitlyn E, Xiang Lingwei, Adler Rachel R, Clark Clancy J, Sepucha Karen, Shah Samir K, Kim Dae Hyun, Hsu John, Weissman Joel S, Schoenfeld Andrew J
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Spine J. 2025 Feb 3. doi: 10.1016/j.spinee.2025.01.040.
As the population ages and surgical techniques improve, more elderly patients with dementia are being considered for treatment of spinal disorders. However, the combined impact of procedural intensity and anesthesia exposure can exacerbate surgical risks, leading to more complex recoveries and postoperative morbidity.
To compare postsurgical outcomes of patients living with dementia who received elective lumbar spine surgery with a comparable group of patients without dementia.
STUDY DESIGN/SETTING: Retrospective analysis using national Medicare claims.
We identified Medicare beneficiaries living with dementia who underwent elective lumbar spine surgery between 2017 and 2018. This cohort was compared to Medicare beneficiaries who received comparable surgeries but without a diagnosis of dementia.
The primary outcome was any adverse event (AAE) within 180 days of surgery, with postoperative intensive interventions considered in parallel with other clinical outcomes.
We employed inverse probability of treatment weights to adjust for confounding. We compared outcomes between cohorts using adjusted hazard ratios (aHR) from Cox-proportional hazard models and Fine-and-gray models considering death as a competing risk.
We included 101,313 patients. Within 180 days of surgery, patients with dementia had an increased hazard of AAE than those without dementia (aHR 1.30; 95% CI 1.21,1.40). Patients with dementia also demonstrated a greater hazard of mortality (aHR 1.75, 95%CI 1.33, 2.29) and postoperative intensive interventions (aHR 1.64, 95% CI 1.08, 2.49) over the same time frame.
We found a significantly increased risk of adverse events among patients living with dementia undergoing lumbar spine surgery. We believe these risks were previously underappreciated because of the focus on urgent procedures (e.g., hip and odontoid fractures) in prior research evaluating postoperative outcomes for patients with dementia. Our results suggest the need for greater caution when recommending elective, high-intensity, surgical interventions for patients living with dementia.
随着人口老龄化以及手术技术的进步，越来越多患有痴呆症的老年患者正在考虑接受脊柱疾病的治疗。然而，手术强度和麻醉暴露的综合影响会加剧手术风险，导致恢复过程更加复杂以及术后发病。
比较接受择期腰椎手术的痴呆症患者与一组可比的非痴呆症患者的术后结果。
研究设计/地点：使用国家医疗保险索赔进行回顾性分析。
我们确定了2017年至2018年间接受择期腰椎手术的患有痴呆症的医疗保险受益人。该队列与接受类似手术但未诊断出痴呆症的医疗保险受益人进行比较。
主要结果是手术后180天内的任何不良事件（AAE），术后强化干预与其他临床结果同时考虑。
我们采用治疗权重的逆概率来调整混杂因素。我们使用来自Cox比例风险模型和考虑死亡作为竞争风险的Fine-and-gray模型的调整后风险比（aHR）比较队列之间的结果。
我们纳入了101,313名患者。在手术后180天内，痴呆症患者发生AAE的风险高于非痴呆症患者（aHR 1.30；95% CI 1.21，1.40）。在同一时间范围内，痴呆症患者的死亡风险（aHR 1.75，95%CI 1.33，2.29）和术后强化干预风险（aHR 1.64，95% CI 1.08，2.49）也更高。
我们发现接受腰椎手术的痴呆症患者发生不良事件的风险显著增加。我们认为，由于先前评估痴呆症患者术后结果的研究侧重于紧急手术（如髋部和齿状突骨折），这些风险此前未得到充分认识。我们的结果表明，在为痴呆症患者推荐择期、高强度手术干预时需要更加谨慎。
