부산대학교 도서관

BACKGROUND CONTEXT Cervical spinal fusion (CF) is employed for treating degenerative spine diseases, which are age-related conditions. Despite the age-dependent nature of these conditions, there is little evidence comparing the outcomes of elderly adults to active adults. It is possible that patient age has a significant effect on postoperative outcomes following cervical spinal fusion. PURPOSE This study evaluated the: (1) demographics, (2) complications, (3) length of stay, (4) hospital charges, (5) reoperations and (6) readmissions following cervical spinal fusion. We hypothesized that elderly patients will experience poorer outcomes compared to younger adults after cervical spinal fusion. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients 45-64years and ≥80years of age who underwent elective cervical spinal fusion between 2009 and 2011 and were eligible for at least two year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 14,578 patients were included, 3.4% of which were ≥80years old and 96.6% of which were 45-64years old. OUTCOME MEASURES Demographic information, complications, length of stay, hospital charges, reoperations and readmissions METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was utilized to identify all elective cervical spinal fusions performed from 2009 to 2011 by ICD-9-CM code. Demographics including age, sex and race as well as perioperative factors, and two year postoperative complication, reoperation and readmission rates were collected for all patients. This cohort was then placed in two groups based on age: 45-64years and ≥80years. Patients outside of these ages were excluded. These two groups were then compared with univariate analysis. Regression models were developed and attempted to identify potential predictive factors for two-year postoperative outcomes. RESULTS A total of 14,578 patients were included, with 96.6% 45-64years (Younger) and 3.4% ≥ 80years (Older) old at time of surgery. Older patients were more commonly male (54.0vs. 50.1%, p<.001) and had Medicare (92.0vs. 11.6%, p<.001). Older patients had significantly higher hospital charges ($84,101.20vs. $47,033.77, p<.001) and longer length of stay (8.5vs. 2.9 day, p<.001) compared to Younger patients. Older patients also had higher complication (23.1vs. 4.7%, p<.001) and reoperation (24.1vs. 13.3%, p<.001) rates, but lower readmission (5.6vs. 13.2%, p<.001) rates. Additionally, Older patients had higher rates of specific complications, including anemia (5.6vs. 0.7%, p<.001), ARDS (3.8vs. 0.7%, p<.001), and DVT (3.6vs. 0.3%, p<.001). Regression analysis revealed that patient age was a significant predictor for higher two-year complication (OR 1.063, p<.001) and revision (OR 1.020, p<.001) rates, but not for higher readmission rate. CONCLUSIONS This study compared outcomes between patients ≥80years old and patients 45-64years old following cervical spinal fusion. The older patient group had higher two-year complication and reoperation rates. Patient age was a significant predictor for higher complication and revision rates. This study should assist spine surgeons preoperatively in risk-stratifying and counseling patients for postoperative outcomes after cervical spinal fusion. [ABSTRACT FROM AUTHOR]