Risk factors of cervical surgery related complications in patients older than 80 years

ORIGINAL ARTICLE

Koji Tamai1), Hidetomi Terai1), Akinobu Suzuki1), Hiroaki Nakamura1), Masaomi Yamashita2), Yawara Eguchi3), Shiro Imagama4), Kei Ando4), Kazuyoshi Kobayashi4), Morio Matsumoto5), Ken Ishii5), Tomohiro Hikata5), Shoji Seki6), Masaaki Aramomi7), Tetsuhiro Ishikawa7), Atsushi Kimura8), Hirokazu Inoue8), Gen Inoue9), Masayuki Miyagi9), Wataru Saito9), Kei Yamada10), Michio Hongo11), Kenji Endo12), Hidekazu Suzuki12), Atsushi Nakano13), Kazuyuki Watanabe14), Junichi Ohya15), Hirotaka Chikuda15), Yasuchika Aoki16), Masayuki Shimizu17), Toshimasa Futatsugi17), Keijiro Mukaiyama17), Masaichi Hasegawa18), Katsuhito Kiyasu19), Haku Iizuka20), Kotaro Nishida21), Kenichiro Kakutani21), Hideaki Nakajima22), Hideki Murakami23), Satoru Demura23), Satoshi Kato23), Katsuhito Yoshioka23), Takashi Namikawa24), Kei Watanabe25)26), Kazuyoshi Nakanishi27), Yukihiro Nakagawa28), Mitsunori Yoshimoto29), Hiroyasu Fujiwara30), Norihiro Nishida31), Masataka Sakane32), Masashi Yamazaki32), Takashi Kaito33), Takeo Furuya34), Sumihisa Orita34), Seiji Ohtori34)

1) Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
2) Department of Orthopedic Surgery, Social Insurance Funabashi Central Hospital, Chiba, Japan
3) Department of Orthopaedic Surgery, Shimoshizu Hospital, Chiba, Japan
4) Department of Orthopaedic Surgery, Nagoya University, Aichi, Japan
5) Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
6) Department of Orthopaedic Surgery, Toyama University, Toyama, Japan
7) Department of Orthopaedic Surgery, Sanmu Medical Center, Chiba, Japan
8) Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
9) Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan
10) Department of Orthopaedic Surgery, Kurume University, Fukuoka, Japan
11) Department of Orthopaedic Surgery, Akita University, Akita, Japan
12) Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
13) Department of Orthopaedic Surgery, Osaka Medical College, Osaka, Japan
14) Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
15) Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan
16) Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Chiba, Japan
17) Department of Orthopaedic Surgery, Shinshu University, Nagano, Japan
18) Department of Orthopaedic Surgery, Kyorin University, Tokyo, Japan
19) Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
20) Department of Orthopaedic Surgery, Gunma University, Gunma, Japan
21) Department of Orthopaedic Surgery, Kobe University, Hyogo, Japan
22) Department of Orthopaedic Surgery, Fukui University, Fukui, Japan
23) Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, Japan
24) Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
25) Department of Orthopaedic Surgery, Niigata University, Niigata, Japan
26) Department of Orthopaedic Surgery, Sado General Hospital, Niigata, Japan
27) Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
28) Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
29) Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan
30) Department of Orthopaedic Surgery, Osaka-Minami Medical Center, Osaka, Japan
31) Department of Orthopaedic Surgery, Yamaguchi University, Yamaguchi, Japan
32) Department of Orthopaedic Surgery, University of Tsukuba, Ibaraki, Japan
33) Department of Orthopaedic Surgery, Osaka University, Osaka, Japan
34) Department of Orthopaedic Surgery, Chiba University, Chiba, Japan

Abstract:

Introduction: With an aging population, the proportion of patients aged ≥80 years requiring cervical surgery is increasing. Surgeons are concerned with the high incidence of complications in this population, because "age" itself has been reported as a strong risk factor for complications. However, it is still unknown which factors represent higher risk among these elderly patients. Therefore, this study was conducted to identify the risk factors related to surgical complications specific to elderly patients by analyzing the registry data of patients aged ≥80 years who underwent cervical surgery.
Methods: We retrospectively studied multicenter collected registry data using multivariate analysis. Sixty-six patients aged ≥80 years who underwent cervical surgery and were followed up for more than one year were included in this study. Preoperative patient demographic data, including comorbidities and postoperative complications, were collected from multicenter registry data. Complications were considered as major if they required invasive intervention, caused prolonged morbidity, or resulted in prolongation of hospital stay. Logistic regression analysis was performed to analyze the risk factors for complications. A p-value of <0.05 was considered as statistically significant.
Results: The total number of patients with complications was 21 (31.8%), with seven major (10.6%) and 14 minor (21.2%) complications. Multivariate logistic regression analysis, after adjusting for age, revealed two significant risk factors: preoperative cerebrovascular disorders (OR, 6.337; p=0.043) for overall complications and cancer history (OR, 8.168; p=0.021) for major complications. Age, presence of diabetes mellitus, and diagnosis were not significant predictive factors for complications in this study.
Conclusions: Preoperative cerebrovascular disorders and cancer history were risk factors for complications after cervical surgery in patients over 80 years old. Surgeons should pay attention to these specific risk factors before performing cervical surgery in elderly patients.

Released: October 27, 2017