Optimal octogenarians: which elderly patients best tolerate adult spinal deformity corrective surgery?

BACKGROUND CONTEXT: Intervention for adult spinal deformity (ASD) can be invasive, and often as patients age, they are more susceptible to the physiological burden imposed by such extensive surgeries. Still studies have proven that rigorous realignment is a target worth pursuing even amongst extremely elderly patients given the potential for significant improvement in quality of life. Herein, we aim to characterize the population of elderly patients who may best tolerate the inherent stresses of ASD surgeries. PURPOSE: To substantiate that not all octogenarians are poor surgical candidates, and the risks of surgery and outcomes vary per age group. STUDY DESIGN/SETTING: Retrospective cohort review of a prospectively collected ASD database. PATIENT SAMPLE: A total of 529 operative ASD patients. OUTCOME MEASURES: complications, alignment. METHODS: Operative ASD patients with preoperative baseline (BL) and 2 year (2Y) radiographic and health-related quality of life data were included. Descriptive statistics and ANOVA testing were applied to characterize and identify differences and associations between the Octo (octogenarian), Septu-five (age 75-80, septuagenarians), Septu (age 70-75), and Nonelderly control cohort (age<70). Regression analyses aided isolation of relevant predictors across the age group. RESULTS: There were 529 patients included, 80.1% of whom were female with mean age of 60.2±14.3, mean BMI 27.1±5.8, mean CCI 1.6±1.7, and mean mASD-FI 6.5± 4.9. In terms of surgical characteristics, the mean operative time 414.1± 175.3 minutes, mean EBL 1565.9± 1387.2 mL, and mean number of levels fused 10.8±4.6. 18 (7.1%) of patients were older than 80 years, 44 (17.4%) were between ages 75-80, 94 (37.2%) fell in the 70-75 group, and 97 (38.2%) in the 65-70 cohort. Only the Septu-five cohort demonstrated a significantly greater BL CCI than the nonelderly group, while the Octo cohort still did not register any significant difference in BL CCI than any of the cohorts. Heart disease was most prevalent at baseline with Septu-Five and Septu cohorts demonstrating the highest rates (39.4%, 36.4%) and Octo and Nonelderly with lower rates (9.1%, 15.2%, p=0.001). In terms of alignment, the Octo group demonstrated the greatest BL GAP score (p=0.02) especially in comparison to the nonelderly cohort, and there was a significantly greater rate of severe SVA deformity amongst the Octo cohort v. the nonelderly (72.7% vs 27.3%, p=0.001). Operatively, there were no significant differences between the levels of fused between the Octo & nonelderly group (9.2 vs 11.74). Still, there was also no significant difference between the rate of complications or reoperations before 2Y between any of the groups, occurrence of radiographic complications or deterioration of alignment, and no differences in rate of attainment of Y1 and Y2 MCID in ODI across the cohorts. Within the optimal octogenarian cohort (those who achieved MCID in ODI or SRS, improvement in Schwab modifiers, or age-adjusted matching), there were significantly fewer patients with high BL SVA (p=.001) or high PI-LL (p=0.029) who attained the ideal state. Furthermore, most octogenarians that reached optimal outcome did not have a BL diagnosis of hypertension (p=0.034). CONCLUSIONS: While age is an important consideration in patient selection, it should not be utilized as a strict exclusion criteria for operative intervention as there are many patients who may benefit greatly despite their age. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Duke Scholars

Author Christopher Ignatius Shaffrey Orthopaedic Surgery

Author Peter Passias Orthopaedic Surgery