Study design: Retrospective analysis.
Objective: Identify if age is a risk factor for postoperative complications after Adult Deformity Surgery (ADS).
Summary of background data: Spinal deformity is a prevalent cause of morbidity in the elderly population, occurring in as many as 68% of patients older than 60 years. Given the increasing prevalence of adult spinal deformities and an aging population, understanding the safety of ADS in elderly patients is becoming increasingly important.
Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥ 18 years of age) from the NSQIP database undergoing ADS were separated into age-based cohorts (≤52, 53–61, 62–69, and ≥70 years of age). Age groups were determined by interquartile analysis. Chi-squared, t-tests, and multivariate logistic regression models were used to identify independent risk factors.
Results: A total of 5,805 patients met the inclusion criteria. Age groups 1, 2, 3, and 4 contained 1,518 (26.1%), 1,478 (25.4%), 1,451 (25.0%), and 1,358 (23.4%) patients, respectively. Multivariate logistic regression analysis revealed increasing age (relative to age group 1) to be an independent risk factor for prolonged length of stay (OR 1.39, CI 1.12–1.69), all complications (OR 1.64, CI 1.35–2.00), renal complications (OR 3.45, CI 1.43–8.33), urinary tract infection (OR 2.70, CI 1.49–4.76), postoperative transfusion (OR 1.47, CI 1.20–1.82), and unplanned readmission (OR 1.64, CI 1.18–2.23). Gradations in odds ratios existed between the different cohorts, such that the deleterious effect of age was less pronounced in cohort 3 compared to cohort 4, and even more less so between cohort 2 and cohort 4.
Conclusion: Age has been shown to be an independent risk factor for increased length of stay, all complications, renal complications, UTI, transfusion, and unplanned readmission.
- adult deformity surgery
- length of stay
- National Surgical Quality Improvement Program