Artikel
Older patients are at risk for internal and surgical complications in surgery of the lumbar spine
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Autoren
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Karl-Michael Schebesch
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Ruth Albert
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Hannah Werle
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Florian Zeman
- Zentrum für klinische Studien am Universitätsklinikum Regensburg, Germany
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Alexander Brawanski
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Due to demographic changes, old and premorbid patients are increasingly submitted for spinal surgery. Procedure-related complications severely impair the recovery after spinal surgery. With this retrospective study, we sought to determine patients-at-risk for any relevant internal or surgical complications.
Method: We revisited our database and reviewed 1.244 patients with lumbar degenerative disk disease, spinal stenosis and instability who had been treated surgically in our department between 2009 and 2014. We screened for internal complications (thromboembolic and cardiac events, pneumonia and sepsis) and for surgical complications (haemorrhage, wound infection, CSF leak). We statistically analysed associations between these complications and 1. diagnosis, 2. extent of surgery (mono-segmental, multi-segmental), 3. duration of surgery, 4. age, and 5. pre-morbid condition (diabetes, cardiac and nephritic morbidity, malignancy).
Results: 103 patients (50 female, 53 male, range 33 to 86 years, mean age 70.0 years, median 67.6 years) with complications were identified (overall morbidity 8.2%). 28.8% (n=28) had internal complications and 78.2% (n=76) had surgical complications. Age and premorbid condition were independently associated with internal complications (p<0.001). Infectious disorders (pneumonia, sepsis) were correlated with multisegmental interventions (p=0.009), duration of surgery (p=0.009), and premorbid condition (p=0.014). Surgical complications were significantly correlated with age (p=0.016), duration of surgery (p=0.014) and occurred significantly more frequent in patients with instability (p <0.001). Wound-healing disorders were associated with coagulopathy (p=0.013) and transfusion (p<0.001).
Conclusions: In this large population of patients with degenerative spinal disorders, we identified predictors that help to characterize patients at risk for internal and surgical complications. These correlations should be taken into account when advising older and premorbid patients on surgery of the lumbar spine.
