What is the effect of advanced age and comorbidity on postoperative morbidity and mortality after musculoskeletal tumor surgery?

Abstract

Although the elderly population is increasing rapidly, little information is available regarding how the risk of postoperative mortality and morbidity increases when combined with age and comorbidity burden in patients undergoing musculoskeletal tumor surgery. We evaluated the effect of age and comorbidity burden on the (1) postoperative complication rate and (2) in-hospital mortality rate after musculoskeletal tumor surgery. We identified 5716 patients undergoing musculoskeletal tumor surgery during 2007 to 2012 using a Japanese national inpatient database. Logistic regression analyses were performed to examine the relationships of various factors with the rates of mortality and morbidity. The postoperative complication rate (6.7%) was associated with male sex (p=0.033), age 80years or older (p=0.001), tumor located in the lower extremity (p=0.001) or trunk (p=0.019), Charlson Comorbidity Index of 4 or greater (p<0.001), blood transfusion (p<0.001), and duration of anesthesia of 240minutes or longer (p<0.001). The in-hospital mortality (0.8%) was related to the Charlson Comorbidity Index of 4 or greater (p<0.001), blood transfusion (p<0.001), and high hospital volume (p=0.016). The morbidity (21.6%; OR, 3.29; p<0.001) and mortality (4.1%; OR, 5.95; p<0.001) in patients 80years or older with a Charlson Comorbidity Index of 4 or greater was increased three and six times, respectively, compared with patients 64years or younger with no comorbidity. We found that age and comorbidity burden together greatly increased the risk of morbidity and mortality. Our study showed quantitative evidence that will assist physicians in assessing perioperative risk accurately and provide a more informative explanation to elderly patients undergoing musculoskeletal tumor surgery. Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.