Risk factors of cervical surgery related complications in patients older than 80 years

Abstract

Abstract:Introduction: With an aging population, the proportion of patients aged ! 80 years requiring cervical surgery is increasing. Surgeons are concerned with the high incidence of complications in this population, because "age" itself has been reported as a strong risk factor for complications. However, it is still unknown which factors represent higher risk among these elderly patients. Therefore, this study was conducted to identify the risk factors related to surgical complications specific to elderly patients by analyzing the registry data of patients aged ! 80 years who underwent cervical surgery. Methods: We retrospectively studied multicenter collected registry data using multivariate analysis. Sixty-six patients aged ! 80 years who underwent cervical surgery and were followed up for more than one year were included in this study. Preoperative patient demographic data, including comorbidities and postoperative complications, were collected from multicenter registry data. Complications were considered as major if they required invasive intervention, caused prolonged morbidity, or resulted in prolongation of hospital stay. Logistic regression analysis was performed to analyze the risk factors for complications. A p-value of <0.05 was considered as statistically significant.Results: The total number of patients with complications was 21 (31.8%), with seven major (10.6%) and 14 minor (21.2%) complications. Multivariate logistic regression analysis, after adjusting for age, revealed two significant risk factors: preoperative cerebrovascular disorders (OR, 6.337; p=0.043) for overall complications and cancer history (OR, 8.168; p= 0.021) for major complications. Age, presence of diabetes mellitus, and diagnosis were not significant predictive factors for complications in this study.Conclusions: Preoperative cerebrovascular disorders and cancer history were risk factors for complications after cervical surgery in patients over 80 years old. Surgeons should pay attention to these specific risk factors before performing cervical surgery in elderly patients.

Delirium Risk Score in Elderly Patients with Cervical Spinal Cord Injury and/or Cervical Fracture

“…On univariate analysis in the conservative cohort, there were significant differences in age ( p < 0.001), pre-injury mobility ( p = 0.028), Hb ( p = 0.038), and Alb levels ( p = 0.011), ASIA Impairment Scale grade ( p = 0.022), number of patients with cervical fracture ( p = 0.025), and comorbid major organ injury ( p = 0.006) between patients with and without delirium ( Table 1 ). After binarizing age, mobility, and Alb and Hb levels using previously published thresholds (age: 80 years, mobility: independent or non-independent, Alb: 3.5 g/dL, Hb: 12 g/dL) [ 19 , 20 , 21 ], the multivariate analysis revealed old age (≥80 years; aOR: 2.26, p = 0.024), hypoalbuminemia (<3.5 g/dL; aOR: 2.15, p = 0.043), cervical fracture (aOR: 2.33, p = 0.020), and comorbid major organ injury (aOR: 2.01, p = 0.045) as independent variables related to the occurrence of delirium in the conservative cohort ( Table 2 ).…”

“…On univariate analysis in the surgical cohort, there were significant differences in age ( p = 0.003), sex ( p < 0.001), pre-injury mobility ( p = 0.024), ASIA Impairment Scale grade ( p = 0.008), number of patients with dementia ( p < 0.001), diabetes ( p = 0.045), cervical fracture ( p = 0.019), cervical OPLL ( p = 0.015), and a signal change in the spinal cord ( p < 0.001) between patients with and without delirium ( Table 3 ). After binarizing age, mobility, and ASIA Impairment Scale grade using previous thresholds (age: 80 years, mobility: independent or non-independent, ASIA Impairment Scale: A, B, or C, D, E) [ 19 , 22 ], the multivariate analysis revealed old age (≥80 years; aOR: 2.75, p < 0.001), dependence in pre-injury mobility (aOR: 2.28, p = 0.023), comorbid diabetes (aOR: 1.91, p = 0.030), and presence of a cervical fracture (aOR: 2.33, p = 0.020) as independent variables related to the occurrence of delirium in the surgical cohort ( Table 4 ).…”

“…For each cohort, significant variables with p < 0.05 on univariate analysis were included in a multivariate analysis as explanatory variables; the presence of delirium was set as the objective variable. In the multivariate analysis, continuous or non-binary data were translated into binary values before calculation using previously reported thresholds [ 19 , 20 , 21 , 22 ]. The adjusted odds ratio (aOR) and 95% confidence interval (CI) of the dependent variables were calculated.…”