Is elective degenerative lumbar spine surgery in older adults safe in a short-stay clinic? Data from an institutional registry.

Abstract

Physicians are increasingly confronted with degenerative spinal pathologies and the possibility of elective surgical treatment in older adults. Little is known on safety and effectiveness of short-stay, elective lumbar spine surgery in this population. We aim to describe patient profiles of older adults undergoing surgery at a specialized short-stay clinic, and describe associated risk profiles and outcomes. From a prospective registry, patients older than 65 were compared to younger controls. All patients underwent a strict anesthesiologic screening preoperatively, leading to a carefully selected cohort of relatively robust older adults suited for safe treatment at a short-stay clinic. A range of perioperative data and reoperations were available from all patients, and a subgroup of patients completed outcome assessments for disability, pain, and health-related quality of life (HRQOL). Of the 3279 included patients, 382 (12%) were older than 65. Older patients presented more often with spinal stenosis, and index levels were placed higher (p < 0.001). While there was no difference in complications, reoperations, and blood loss (p > 0.05), older people had longer surgical times and length of stay, although not by a clinically relevant margin (p < 0.001). Long-term patient-reported outcomes were equal (p > 0.05). However, older adults had worse 6-week outcomes for leg pain, functional disability, and HRQOL (all p < 0.05). Higher age should not be considered a contraindication for elective lumbar spine surgery at short-stay clinics. If the anesthesiologic risk can be controlled, conservative treatments have failed, and muscle-sparing techniques are applied, favorable outcomes can be achieved with an acceptable risk profile in a safe manner.