The impact of advanced age on peri-operative outcomes in the surgical treatment of cervical spondylotic myelopathy

Cyrus M. Jalai, Nancy Worley, Bryan Marascalchi, Vincent Challier, Shaleen Vira, Sun Yang, Anthony J. Boniello, John A. Bendo, Virginie Lafage, Peter G. Passias

Research output: Contribution to journalArticle

Abstract

Study Design. Retrospective multicenter database review. Objective. The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients. Summary of Background Data. Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients. Methods. A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]). Results. Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate (11.39% vs. 5.93%, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P<0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses (5.77 vs. 4.28 days, P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate (13.87% vs. 10.20%, P<0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P<0.001), digestive system (1.92 [2.40-1.54], P<0.001), and wound dehiscence (1.71 [2.56-1.15], P<0.001). Conclusion. Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.

Original languageEnglish (US)
Pages (from-to)E139-E147
JournalSpine
Volume41
Issue number3
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Spondylosis
Perioperative Care
Cervical Vertebrae
Spinal Fusion
Spinal Cord Diseases
Age Factors
Length of Stay
Cohort Studies
Retrospective Studies
Morbidity
Mortality
Age Groups
Therapeutics
Comorbidity
Laminoplasty
Hospital Charges
Digestive System
Inpatients
Shock
Spine

Keywords

  • age
  • cervical spondylotic myelopathy
  • complications
  • elderly
  • length of stay
  • morbidity
  • mortality
  • national trends
  • Nationwide Inpatient Sample
  • outcomes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

The impact of advanced age on peri-operative outcomes in the surgical treatment of cervical spondylotic myelopathy. / Jalai, Cyrus M.; Worley, Nancy; Marascalchi, Bryan; Challier, Vincent; Vira, Shaleen; Yang, Sun; Boniello, Anthony J.; Bendo, John A.; Lafage, Virginie; Passias, Peter G.

In: Spine, Vol. 41, No. 3, 01.02.2016, p. E139-E147.

Research output: Contribution to journalArticle

Jalai, CM, Worley, N, Marascalchi, B, Challier, V, Vira, S, Yang, S, Boniello, AJ, Bendo, JA, Lafage, V & Passias, PG 2016, 'The impact of advanced age on peri-operative outcomes in the surgical treatment of cervical spondylotic myelopathy', Spine, vol. 41, no. 3, pp. E139-E147. https://doi.org/10.1097/BRS.0000000000001181
Jalai, Cyrus M. ; Worley, Nancy ; Marascalchi, Bryan ; Challier, Vincent ; Vira, Shaleen ; Yang, Sun ; Boniello, Anthony J. ; Bendo, John A. ; Lafage, Virginie ; Passias, Peter G. / The impact of advanced age on peri-operative outcomes in the surgical treatment of cervical spondylotic myelopathy. In: Spine. 2016 ; Vol. 41, No. 3. pp. E139-E147.
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abstract = "Study Design. Retrospective multicenter database review. Objective. The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients. Summary of Background Data. Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients. Methods. A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95{\%} CI]). Results. Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate (11.39{\%} vs. 5.93{\%}, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P<0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses (5.77 vs. 4.28 days, P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate (13.87{\%} vs. 10.20{\%}, P<0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P<0.001), digestive system (1.92 [2.40-1.54], P<0.001), and wound dehiscence (1.71 [2.56-1.15], P<0.001). Conclusion. Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.",
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T1 - The impact of advanced age on peri-operative outcomes in the surgical treatment of cervical spondylotic myelopathy

AU - Jalai, Cyrus M.

AU - Worley, Nancy

AU - Marascalchi, Bryan

AU - Challier, Vincent

AU - Vira, Shaleen

AU - Yang, Sun

AU - Boniello, Anthony J.

AU - Bendo, John A.

AU - Lafage, Virginie

AU - Passias, Peter G.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Study Design. Retrospective multicenter database review. Objective. The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients. Summary of Background Data. Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients. Methods. A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]). Results. Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate (11.39% vs. 5.93%, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P<0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses (5.77 vs. 4.28 days, P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate (13.87% vs. 10.20%, P<0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P<0.001), digestive system (1.92 [2.40-1.54], P<0.001), and wound dehiscence (1.71 [2.56-1.15], P<0.001). Conclusion. Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.

AB - Study Design. Retrospective multicenter database review. Objective. The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients. Summary of Background Data. Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients. Methods. A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]). Results. Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate (11.39% vs. 5.93%, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P<0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses (5.77 vs. 4.28 days, P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate (13.87% vs. 10.20%, P<0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P<0.001), digestive system (1.92 [2.40-1.54], P<0.001), and wound dehiscence (1.71 [2.56-1.15], P<0.001). Conclusion. Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.

KW - age

KW - cervical spondylotic myelopathy

KW - complications

KW - elderly

KW - length of stay

KW - morbidity

KW - mortality

KW - national trends

KW - Nationwide Inpatient Sample

KW - outcomes

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