P124. Central Cord Syndrome: Should age influence surgical decision and timing?

Abstract

<h3>BACKGROUND CONTEXT</h3> As surgery is increasingly recommended for patients with spinal instability and neurologic deterioration secondary to central cord syndrome (CCS), it is important to investigate the impact age has on postoperative complication rates. <h3>PURPOSE</h3> Investigate associations of age and surgical decision and timing of procedure. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of Health care Cost and Utilization Project's Nationwide Inpatient Sample (NIS). <h3>PATIENT SAMPLE</h3> CCS patients. <h3>OUTCOME MEASURES</h3> Surgical timing and postop complications. <h3>METHODS</h3> CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18) were isolated in the NIS database 2007-2016. As appropriate, analysis of variance and chi-squared tests compared demographics, and Charlson Comorbidity Index (CCI) scores. Patients were then stratified by age into 4 percentiles (1st: 13-48, 2nd: 49-50, 3rd: 59-68, 4th: 69-90). Surgical decision-making such as approach and surgical timing were analyzed for their association with postoperative complications via logistic regressions controlling for CCI. An age cutoff in relation to postop complications was identified via Receiver Operating Curve (ROC). <h3>RESULTS</h3> There were 5,725 CCS patients included (59.5years, 1.3 CCI, 26% Female). By age percentile, those that were in the lowest had greater rates of decompressions (71.8%), fusions (88.4%), combined approach (5.1%), anterior approach (64.4%), and 9+ levels fused (3.5%; all p<0.001). Those in the highest percentile had greater rates of posterior approach (38.4%) and greater CCI (1.8), whereas those in the 3rd percentile had the greatest fusion rate for 4-8 levels (11.9%; all p<0.001). Controlling for CCI, those in the 3rd percentile for age were associated with posterior perioperative complications (1.8[1.4-2.3]), those in 2nd were associated anterior complications (7[5.2-9.5]), and those in the lowest percentile group were associated with combined approach complications (3.4[1.8-6.4-; p<0.05). More specifically, patients in the 4th percentile had increased odds at developing neurologic issues (OR:2.6) whereas those in the 3rd had greater odds of cardiac complications postop (OR:3.6; p<0.05). Disposition status was also affected by age, with those in the highest percentile experiencing greater rates of death after being discharged (12.1[9.5-15.2; p<0.001). Patients in the 4th percentile had the most extreme loss of function (7.4[6.5-8.5]; p<0.05). By surgical timing, there was no increased rate of complications among the age groups for same day procedures. However, delaying surgery by 2 or 3 days was identified to be associated with increased complications for the lowest percentile group (OR:5.2 and OR:7.1 respectively; p<0.05). With a greater increase in delay of surgery of 8-14 days (3.9[2.1-7.3]) and 15+ (14.1[8.4-23.7]) were identified to be significant procedure time points of developing complications for patients in the 3rd percentile. Overall, patients>59 years had an increased likelihood of postoperative complication development (AUC: 0.5, p=0.002). <h3>CONCLUSIONS</h3> Age overall played a role in postoperative complications when >59 years. It also played a significant role in surgical timing and surgical approach. Adequately stratifying patients diagnosed with Central Cord Syndrome in accordance to their age profile can minimize postoperative complications. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.