Ohira Shunsuke, Yamato Yukimasa, Taniguchi Yuki, Kawamura Naohiro, Iizuka Tetsusai, Higashikawa Akiro, Komatsu Naoto, Takeshita Yujiro, Tozawa Keiichiro, Fukushima Masayoshi, Urayama Daiki, Ono Takashi, Hara Nobuhiro, Masuda Kazuhiro, Azuma Seiichi, Iwai Hiroki, Oshina Masahito, Sugita Shurei, Hirai Shima, Sasaki Katsuyuki, Nakarai Hiroyuki, Ohtomo Nozomu, Nakamoto Hideki, Kato So, Matsubayashi Yoshitaka, Tanaka Sakae, Oshima Yasushi
Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
University of Tokyo Spine Group (UTSG), Tokyo, Japan.
Spine Surg Relat Res. 2024 Dec 20;9(3):331-338. doi: 10.22603/ssrr.2024-0225. eCollection 2025 May 27.
Despite an increase in the demand for surgical treatment of elderly patients with degenerative spinal disorders, little is known about mortality following spinal surgery in this population. This study aims to identify the incidence and causes of in-hospital mortality in elderly patients after elective spine surgery.
We extracted the data of patients aged ≥65 years who underwent elective spine surgery between December 12, 2016, and May 31, 2022, from our prospective multicenter cohort. The primary outcome was the in-hospital mortality rate. Univariate analysis was conducted to identify potential risk factors for postoperative mortality. The detailed clinical course of patients who died was retrospectively investigated using medical records.
A total of 10,976 eligible patients (5,976 males and 5,000 females), with a mean age of 75.5 years, were identified. There were eight in-hospital deaths (0.07%). Univariate analyses showed that the eight patients were significantly older (82.1 years vs. 75.5 years, P=0.008), were more frequently hemodialysis-dependent (50.0% vs. 2.9%, P<0.001), and had a higher proportion of cases with cervical surgery (62.5% vs. 17.0%, P<0.001) and preoperative American Society of Anesthesiologists Physical Status ≥3 (87.5% vs. 14.6%, P<0.001). Death occurred at a median of 24.5 days postoperatively. The causes of in-hospital death were as follows: gastrointestinal diseases in five cases (ischemic colitis in three cases, panperitonitis in one, and intestinal perforation in one), sepsis due to unknown causes in two, and lethal arrhythmia in one. The initial symptoms preceding the lethal clinical course were mainly common gastrointestinal symptoms, such as abdominal pain, anorexia, diarrhea, and vomiting.
The main cause of in-hospital mortality was gastrointestinal disease. Surgeons should be aware that common gastrointestinal symptoms can be the initial symptoms of a subsequent lethal clinical course in elderly patients.
尽管老年退行性脊柱疾病患者的手术治疗需求有所增加，但对于该人群脊柱手术后的死亡率知之甚少。本研究旨在确定择期脊柱手术后老年患者的院内死亡率及原因。
我们从前瞻性多中心队列中提取了2016年12月12日至2022年5月31日期间接受择期脊柱手术的65岁及以上患者的数据。主要结局是院内死亡率。进行单因素分析以确定术后死亡的潜在危险因素。使用病历对死亡患者的详细临床过程进行回顾性调查。
共确定了10976例符合条件的患者（5976例男性和5000例女性），平均年龄为75.5岁。有8例院内死亡（0.07%）。单因素分析显示，这8例患者年龄显著更大（82.1岁对75.5岁，P=0.008），更频繁依赖血液透析（50.0%对2.9%，P<0.001），颈椎手术病例比例更高（62.5%对17.0%，P<0.001），术前美国麻醉医师协会身体状况≥3级的比例更高（87.5%对14.6%，P<0.001）。死亡发生在术后中位数24.5天。院内死亡原因如下：5例为胃肠道疾病（3例缺血性结肠炎、1例全腹膜炎和1例肠穿孔），2例为不明原因的败血症，1例为致命性心律失常。致命临床过程之前的初始症状主要是常见的胃肠道症状，如腹痛、厌食、腹泻和呕吐。
院内死亡的主要原因是胃肠道疾病。外科医生应意识到，常见的胃肠道症状可能是老年患者随后致命临床过程的初始症状。
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