Kosaka Masahiro, Kato So, Nakarai Hiroyuki, Nakamoto Hideki, Doi Toru, Matsubayashi Yoshitaka, Taniguchi Yuki, Tachibana Naohiro, Hirai Shima, Fukushima Masayoshi, Oshina Masahito, Takeshita Yujiro, Sugita Shurei, Okazaki Rentaro, Masuda Kazuhiro, Ono Takashi, Higashikawa Akiro, Kawamura Naohiro, Iwai Hiroki, Tanaka Sakae, Oshima Yasushi
Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
Department of Orthopaedics, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
Spine Surg Relat Res. 2024 Aug 22;9(2):140-147. doi: 10.22603/ssrr.2024-0071. eCollection 2025 Mar 27.
Due to global increases in life expectancy, numbers of both super-elderly patients (≥90 years old) and the spine surgeries they undergo are increasing. However, no studies on spine surgery for super-elderly patients have focused on patient-reported outcomes (PROs).
Subjects were elderly patients (over 75 years old) undergoing spine surgery for degenerative disease (4408 cases) performed at our 13 affiliated centers between April 2017 and August 2021. Surgical procedures, perioperative complications, and PROs were investigated and compared between patients ≥90 years old (SE group) and control patients 75-89 years old (E group).
Although the two groups showed no significant differences in patient background, the SE group showed significantly fewer fusions. The incidence of perioperative complications, including death within 30 days, did not significantly differ between groups. Regarding PROs, there were no significant differences in percentages of patients who achieved minimum clinically important differences in Neck Disability Index, Oswestry Disability Index, or EuroQoL 5 Dimension. There were no significant differences in pre- and postoperative numeric rating scales for each item or patient satisfaction.
There were significant improvements in PROs at 1 year postoperatively in the SE group than in the E group, and there were no significant differences in perioperative complication rates or mortality.
由于全球预期寿命的增加,超级老年患者(≥90岁)的数量及其接受的脊柱手术数量都在上升。然而,尚无关于超级老年患者脊柱手术的研究关注患者报告结局(PROs)。
研究对象为2017年4月至2021年8月期间在我们13个附属医院中心接受退行性疾病脊柱手术的老年患者(75岁以上)(4408例)。对90岁及以上患者(超级老年组)和75 - 89岁对照患者(老年组)的手术操作、围手术期并发症和PROs进行调查和比较。
尽管两组患者的背景无显著差异,但超级老年组的融合手术明显较少。包括30天内死亡在内的围手术期并发症发生率在两组间无显著差异。关于PROs,在颈部残疾指数、奥斯威斯利残疾指数或欧洲五维健康量表中达到最小临床重要差异的患者百分比无显著差异。各项目术前和术后数字评分量表及患者满意度均无显著差异。
超级老年组术后1年的PROs改善程度显著高于老年组,围手术期并发症发生率和死亡率无显著差异。