Risk factors related to perioperative systemic complications and mortality in elderly patients with osteoporotic vertebral fractures—analysis of a large national inpatient database

Abstract

Background The surgical treatment of osteoporotic vertebral fractures (OVF) is generally associated with a high risk of complications due to an aging population with osteoporosis; however, the detailed risk factors for systemic complications and mortality have not been clarified. We evaluated the risk factors for systemic complications and mortality in surgically treated OVF patients using a large national inpatient database. Methods Patients over 65 years old who were diagnosed with OVF and received either anterior fusion (AF) or posterior fusion (PF), from 2012 to 2016, were extracted from the diagnosis procedure combination (DPC) database. In each of the perioperative systemic complications (+) or (−) group, and the in-hospital death (+) or (−) group, we surveyed the various risk factors related to perioperative systemic complications and in-hospital death. Results The significant factors associated with systemic complications were older age (OR 1.38, 95% CI 1.09–1.74), a lower activity of daily living score upon admission (OR 1.52, 95%CI 1.19–1.94), atrial fibrillation (OR 2.14, 95%CI 1.25–3.65), renal failure (OR 2.29, 95%CI 1.25–4.20), and surgical procedure (AF, OR 1.73, 95%CI 1.35–2.22). The significant explanatory variables for in-hospital death were revealed to be male sex (OR 3.26, 95%CI 1.20–8.87), a lower body mass index (OR 3.97, 95%CI 1.23–12.86), unscheduled admission (OR 3.52, 95%CI 1.17–10.63), atrial fibrillation (OR 8.31, 95%CI 2.25–30.70), renal failure (OR 7.15, 95%CI 1.32-38.77), and schizophrenia (OR 8.23, 95%CI 1.66–42.02). Conclusions Atrial fibrillation and renal failure as preoperative comorbidities were common factors between perioperative systemic complications and mortality in elderly patients for OVF.

Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture

“…Surgical indications included more than 50% loss of anterior vertebral body height (AVH), regional kyphotic deformity more than 20 ° or significant posterior element lesion. The inclusion criteria included (1) single-level AO A3 or A4 type burst fracture between T11-L2 [ 2 , 14 ] osteoporosis: mean T score by BMD (bone mineral density) < − 2.5; (3) no neurological deficits; (4) less than 2 weeks from the time of injury to surgery. The exclusion criteria were as follow: (1) two or more levels thoracolumbar burst fractures; (2) pathological fracture; (3) inflammatory diseases (ankylosing spondylitis, rheumatoid arthritis or active infection); (4) a history of major thoracolumbar spinal surgery.…”

“…Anterior approach or combined surgery can directly reconstruct anterior column, decompress neurological structure and provide superior biomechanical stability. However, these surgeries are fraught with complication due to debilitated state of elderly patients [ 2 , 3 ]. When posterior approach is performed, controversy exists regarding the use of fixation by short or long-segment pedicle screws [ 4 ].…”

Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization

“…11 Higher ASA score is also associated with the increased risk in patients with lower activity of daily living (ADL) levels upon admission or partial or complete dependence. 4,9,11 Also, the inpatient admission status seems to influence the clinical outcome. 4,13 One reason could be that the collective of patients with an inpatient status before admission had more severe fractures.…”

Innovation in Orthopedics: Part 1—Design Thinking

“… Understanding the nature of problems : design, as the science of the artificial [ 58 ], is well-suited for approaching complex problems, yet it is of little use when solving well-defined problems. Design thinking initiatives are human-centered, such as designing for an aging population, that will be more functionally dependent [ 59 ], demanding initiatives to maintain the physical capacity [ 60 ], with greater probability of accessing healthcare services [ 47 ], considering the need for “social distancing” caused by the COVID-19 pandemic that complicates traditional care model for recovery after medical procedures that demand intensive physical therapies [ 37 ]. Moreover, to align current and future services, new models of care need to be developed, to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost [ 4 , 17 ].…”