The following is the summary of “Are Octogenarians at Higher Risk of Complications After Elective Lumbar Spinal Fusion Surgery? Analysis of a Cohort of 7880 Patients From the Kaiser Permanente Spine Registry” published in the December 2022 issue of Spine by Kuo et al.

Review of medical records from a previously collected cohort. The study’s goal is to compare patients aged 50–79 with patients aged 80–89 who underwent elective posterior instrumented lumbar spinal fusions to identify any age-related differences in the likelihood of poor outcomes. There has been a rise in the number of patients aged 80 and more who choose for lumbar spinal fusion surgery. The risks of intraoperative and postoperative complications in these patients have been shown to be inconsistently high and low. Time-dependent multivariate Cox proportional hazards regression with a competing risk of death and multivariate logistic regression were used to compare patients aged 80 and up to those aged 50 to 79 (reference group) for longitudinal outcomes, and to predict binary outcomes, respectively. 

Durotomy was utilized as an intraoperative outcome measure, while pneumonia and other postoperative complications at 30 and 90 days, as well as death and readmission at 2 years, were employed as postoperative outcomes (reoperations and mortality). In this study, 7880 individuals with degenerative disk disease or spondylolisthesis who had had primary elective posterior instrumented lumbar spinal fusion (L1-S1) made up the group. A total of 596 patients were 80 or older, while the remaining 7284 were between the ages of 50 and 79. Patients aged 80 and up had a greater risk of durotomy (odds ratio (OR)=1.43, 95% confidence interval(CI)=1.02-2.02) and 30-day pneumonia (OR=1.81, 95% CI=1.01-3.23) after correction. However, the likelihood of requiring a second operation was reduced if it occurred within two years of the index procedure (hazard ratio=0.69, 95% CI=0.48-0.99). 

The rates of death, hospital readmission, trips to the emergency department, pulmonary embolism , or deep vein thrombosis were not different. Although higher durotomies and 30-day pneumonia were more common in patients aged 80 and up, researchers did not find any other significant differences in the risks of adverse events between patients aged 50-79 and those aged 80 and up in a cohort of 7,880 patients undergoing elective posterior instrumented lumbar fusion for degenerative disk disease or spondylolisthesis. In their opinion, lumbar fusions are safe for the elderly, but the risks of 30-day pneumonia can be mitigated with careful preoperative screening.