Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge

Meghan E. Murphy, Hannah Gilder, Patrick R. Maloney, Brandon A. McCutcheon, Lorenzo Rinaldo, Daniel Shepherd, Panagiotis Kerezoudis, Daniel S. Ubl, Cynthia Crowson, William E. Krauss, Elizabeth B Habermann, Mohamad Bydon

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE With improving medical therapies for chronic conditions, elderly patients increasingly present as candidates for operative intervention for degenerative diseases of the spine. To date, there is a paucity of studies examining complications in lumbar decompression, without fusion, that include patients older than 80 years. Using a multicenter national database, the authors of this study evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes. METHODS The 2011-2013 American College of Surgeons' National Surgical Quality Improvement Program data set was queried for patients 65 years and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion. Morbidity and mortality within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission within 30 days or discharge to a nonhome facility. Outcomes and operative characteristics were compared using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression models. RESULTS A total of 8744 patients were identified; of these patients 4573 (52.30%) were 65 years and older. Elderly patients were stratified into 3 age categories: 85 years or older (n = 314), 75-84 years (n = 1663), and 65-74 years (n = 2596). Univariate analysis showed that, compared with age younger than 65 years, increased age was associated with the number of levels (≥ 3), readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion (all p < 0.001). On multivariable analysis and with younger than 65 years as the reference, increased age was associated with any minor complication (p < 0.001; ≥ 85 years: OR 3.47, 95% CI 1.69-7.13; 75-84 years: OR 2.34, 95% CI 1.45-3.78; and 65-74 years: OR 1.44, 95% CI 0.94-2.20), as well as discharge location other than home (p < 0.001; ≥ 85 years: OR 13.59, 95% CI 9.47-19.49; 75-84 years: OR 5.64, 95% CI 4.33-7.34; and 65-74 years: OR 2.61, 95% CI 2.05-3.32). CONCLUSIONS The authors' high-powered, multicenter analysis of lumbar decompression without fusion in the elderly, specifically including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.

Original languageEnglish (US)
Pages (from-to)353-362
Number of pages10
JournalJournal of neurosurgery. Spine
Volume26
Issue number3
DOIs
StatePublished - Mar 1 2017

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Decompression
Length of Stay
Spine
Logistic Models
Chi-Square Distribution
Quality Improvement
Postoperative Period
Blood Transfusion
Databases
Morbidity
Mortality

Keywords

  • ACS-NSQIP = American College of Surgeons' National Surgical Quality Improvement Program
  • ASA = American Society of Anesthesiologists
  • BMI = body mass index
  • BUN = blood urea nitrogen
  • CHF = congestive heart failure
  • CKD = chronic kidney disease
  • COPD = chronic obstructive pulmonary disease
  • CPT = Current Procedural Terminology
  • degenerative spine disease
  • DVT = deep vein thrombosis
  • eGFR = estimated GFR
  • elderly
  • GFR = glomular filtration rate
  • INR = international normalized ratio
  • IQR = interquartile range
  • lumbar decompression
  • NSQIP
  • postoperative complications
  • SSI = surgical site infection
  • UTI = urinary tract infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Murphy, M. E., Gilder, H., Maloney, P. R., McCutcheon, B. A., Rinaldo, L., Shepherd, D., ... Bydon, M. (2017). Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge. Journal of neurosurgery. Spine, 26(3), 353-362. https://doi.org/10.3171/2016.8.SPINE16616

Lumbar decompression in the elderly : increased age as a risk factor for complications and nonhome discharge. / Murphy, Meghan E.; Gilder, Hannah; Maloney, Patrick R.; McCutcheon, Brandon A.; Rinaldo, Lorenzo; Shepherd, Daniel; Kerezoudis, Panagiotis; Ubl, Daniel S.; Crowson, Cynthia; Krauss, William E.; Habermann, Elizabeth B; Bydon, Mohamad.

In: Journal of neurosurgery. Spine, Vol. 26, No. 3, 01.03.2017, p. 353-362.

Research output: Contribution to journalArticle

Murphy, ME, Gilder, H, Maloney, PR, McCutcheon, BA, Rinaldo, L, Shepherd, D, Kerezoudis, P, Ubl, DS, Crowson, C, Krauss, WE, Habermann, EB & Bydon, M 2017, 'Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge', Journal of neurosurgery. Spine, vol. 26, no. 3, pp. 353-362. https://doi.org/10.3171/2016.8.SPINE16616
Murphy, Meghan E. ; Gilder, Hannah ; Maloney, Patrick R. ; McCutcheon, Brandon A. ; Rinaldo, Lorenzo ; Shepherd, Daniel ; Kerezoudis, Panagiotis ; Ubl, Daniel S. ; Crowson, Cynthia ; Krauss, William E. ; Habermann, Elizabeth B ; Bydon, Mohamad. / Lumbar decompression in the elderly : increased age as a risk factor for complications and nonhome discharge. In: Journal of neurosurgery. Spine. 2017 ; Vol. 26, No. 3. pp. 353-362.
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author = "Murphy, {Meghan E.} and Hannah Gilder and Maloney, {Patrick R.} and McCutcheon, {Brandon A.} and Lorenzo Rinaldo and Daniel Shepherd and Panagiotis Kerezoudis and Ubl, {Daniel S.} and Cynthia Crowson and Krauss, {William E.} and Habermann, {Elizabeth B} and Mohamad Bydon",
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TY - JOUR

T1 - Lumbar decompression in the elderly

T2 - increased age as a risk factor for complications and nonhome discharge

AU - Murphy, Meghan E.

AU - Gilder, Hannah

AU - Maloney, Patrick R.

AU - McCutcheon, Brandon A.

AU - Rinaldo, Lorenzo

AU - Shepherd, Daniel

AU - Kerezoudis, Panagiotis

AU - Ubl, Daniel S.

AU - Crowson, Cynthia

AU - Krauss, William E.

AU - Habermann, Elizabeth B

AU - Bydon, Mohamad

PY - 2017/3/1

Y1 - 2017/3/1

N2 - OBJECTIVE With improving medical therapies for chronic conditions, elderly patients increasingly present as candidates for operative intervention for degenerative diseases of the spine. To date, there is a paucity of studies examining complications in lumbar decompression, without fusion, that include patients older than 80 years. Using a multicenter national database, the authors of this study evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes. METHODS The 2011-2013 American College of Surgeons' National Surgical Quality Improvement Program data set was queried for patients 65 years and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion. Morbidity and mortality within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission within 30 days or discharge to a nonhome facility. Outcomes and operative characteristics were compared using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression models. RESULTS A total of 8744 patients were identified; of these patients 4573 (52.30%) were 65 years and older. Elderly patients were stratified into 3 age categories: 85 years or older (n = 314), 75-84 years (n = 1663), and 65-74 years (n = 2596). Univariate analysis showed that, compared with age younger than 65 years, increased age was associated with the number of levels (≥ 3), readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion (all p < 0.001). On multivariable analysis and with younger than 65 years as the reference, increased age was associated with any minor complication (p < 0.001; ≥ 85 years: OR 3.47, 95% CI 1.69-7.13; 75-84 years: OR 2.34, 95% CI 1.45-3.78; and 65-74 years: OR 1.44, 95% CI 0.94-2.20), as well as discharge location other than home (p < 0.001; ≥ 85 years: OR 13.59, 95% CI 9.47-19.49; 75-84 years: OR 5.64, 95% CI 4.33-7.34; and 65-74 years: OR 2.61, 95% CI 2.05-3.32). CONCLUSIONS The authors' high-powered, multicenter analysis of lumbar decompression without fusion in the elderly, specifically including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.

AB - OBJECTIVE With improving medical therapies for chronic conditions, elderly patients increasingly present as candidates for operative intervention for degenerative diseases of the spine. To date, there is a paucity of studies examining complications in lumbar decompression, without fusion, that include patients older than 80 years. Using a multicenter national database, the authors of this study evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes. METHODS The 2011-2013 American College of Surgeons' National Surgical Quality Improvement Program data set was queried for patients 65 years and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion. Morbidity and mortality within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission within 30 days or discharge to a nonhome facility. Outcomes and operative characteristics were compared using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression models. RESULTS A total of 8744 patients were identified; of these patients 4573 (52.30%) were 65 years and older. Elderly patients were stratified into 3 age categories: 85 years or older (n = 314), 75-84 years (n = 1663), and 65-74 years (n = 2596). Univariate analysis showed that, compared with age younger than 65 years, increased age was associated with the number of levels (≥ 3), readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion (all p < 0.001). On multivariable analysis and with younger than 65 years as the reference, increased age was associated with any minor complication (p < 0.001; ≥ 85 years: OR 3.47, 95% CI 1.69-7.13; 75-84 years: OR 2.34, 95% CI 1.45-3.78; and 65-74 years: OR 1.44, 95% CI 0.94-2.20), as well as discharge location other than home (p < 0.001; ≥ 85 years: OR 13.59, 95% CI 9.47-19.49; 75-84 years: OR 5.64, 95% CI 4.33-7.34; and 65-74 years: OR 2.61, 95% CI 2.05-3.32). CONCLUSIONS The authors' high-powered, multicenter analysis of lumbar decompression without fusion in the elderly, specifically including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.

KW - ACS-NSQIP = American College of Surgeons' National Surgical Quality Improvement Program

KW - ASA = American Society of Anesthesiologists

KW - BMI = body mass index

KW - BUN = blood urea nitrogen

KW - CHF = congestive heart failure

KW - CKD = chronic kidney disease

KW - COPD = chronic obstructive pulmonary disease

KW - CPT = Current Procedural Terminology

KW - degenerative spine disease

KW - DVT = deep vein thrombosis

KW - eGFR = estimated GFR

KW - elderly

KW - GFR = glomular filtration rate

KW - INR = international normalized ratio

KW - IQR = interquartile range

KW - lumbar decompression

KW - NSQIP

KW - postoperative complications

KW - SSI = surgical site infection

KW - UTI = urinary tract infection

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