Short-term outcomes following posterior cervical fusion among octogenarians with cervical spondylotic myelopathy: a NSQIP database analysis

Publication date: September 2018

Source: The Spine Journal, Volume 18, Issue 9

Author(s): Caroline E. Vonck, Joseph E. Tanenbaum, Thomas T. Bomberger, Edward C. Benzel, Jason W. Savage, Iain H. Kalfas, Thomas E. Mroz, Michael P. Steinmetz

Abstract

Background Context

Degenerative changes in the cervical spine occur in an age-dependent manner. As the US population continues to age, the incidence of age-dependent, multilevel, degenerative cervical pathologies is expected to increase. Similarly, the average age of patients with cervical spondylotic myelopathy (CSM) will likely trend upward. Posterior cervical fusion (PCF) is often the treatment modality of choice in the management of multilevel cervical spine disease. Although outcomes following anterior cervical fusion for degenerative disease have been studied among older patients (aged 80 years and older), it is unknown if these results extend to octogenarian patients undergoing PCF for the surgical management of CSM.

Purpose

The present study aimed to quantify surgical outcomes following PCF for the treatment of CSM among the octogenarian patient population compared with patients younger than 80 years old.

Study Design/Setting

This was a retrospective study that used the National Surgical Quality Improvement Program (NSQIP).

Patient Sample

The sample included patients aged 60–89 who had CSM and who underwent PCF from 2012 to 2014.

Outcome Measures

The outcome measures were multimorbidity, prolonged length of stay (LOS), discharge disposition (to home or skilled nursing/rehabilitation facility), 30-day all-cause readmission, and 30-day reoperation.

Methods

The NSQIP database was queried for patients with CSM (International Classification of Disease, Ninth Revision, Clinical Modification code 721.1) aged 60–89 who underwent PCF (Current Procedural Terminology code 22600) from 2012 to 2014. Cohorts were defined by age group (60–69, 70–79, 80–89). Data were collected on gender, race, elective or emergent status, inpatientor outpatient status, where patients were admitted from (home vs. skilled nursing facility), American Society of Anesthesiologists class, comorbidities, and single- or multilevel fusion. After controllingfor these variables, logistic regression analysis was used to compare outcome measures in the different age groups.

Results

A total of 819 patients with CSM who underwent PCF (416 aged 60–69, 320 aged 70–79, and 83 aged 80–89) were identified from 2012 to 2014. Of the PCF procedures, 79.7% were multilevel. There were no significant differences in the odds of multimorbidity, prolonged LOS, readmission, or reoperation when comparing octogenarian patients with CSM with patients aged 60–69 or 70–79. Patients aged 60–69 and 70–79 were significantly more likely to be discharged to home than patients over 80 (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8–10.4, p<.0001, and OR 2.7, 95% CI 1.1–6.4, p=.0005, respectively).

Conclusions

Compared with patients aged 60–69 and 70–79, octogenarian patients with CSM were significantly more likely to be discharged to a location other than home following PCF. After controlling for patient comorbidities and demographics, 80- to 89-year-old patients with CSM who underwent PCF did not differ in other outcomes when compared with the other age cohorts. These results can improve preoperative risk counseling and surgical decision-making.

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