gms | German Medical Science

Objective: The lumbar spinal stenosis (LSS) is a common disease of the older population. The progressive ageing and accessibility of medical diagnostics/care result in an increased number of geriatric patients, who undergo a surgery for LSS. Most of the studies about postoperative results in geriatric patients with LSS define a geriatric patient only using his/her calendrical age (older than 65 or 70 years). According to German section of geriatrics (DGG) not every older patient is a geriatric one. Therefore biological age has to be prioritized instead of the calendrical age. The aim of this study was to compare the perioperative complication rate after LSS-surgery in geriatric and non-geriatric old aged patients.

Methods: In cooperation with geriatric department of our hospital we retrospectively studied 93 patients with the age of over 70 years who underwent the decompression surgery due to LSS in our department between January 2013 and April 2015. The geriatric group consisted of patients with typical geriatric multimorbidity and polypharmacy (n=47, average age-76.6 years). The non-geriatric group consisted of patients without the above-mentioned signs (n=46, average age=76.9 years). In each patient a bilateral decompression via unilateral approach (undercutting) was performed. One segment pathologies were treated with partial hemilaminectomy and contralateral undercutting. In case of two or more stenotic segments a hemilaminectomy with contralateral undercutting was performed. We analyzed the period of hospitalization (including: ASA-score, BMI, operated segments, anticoagulants, gender etc.) in both groups, respectively. Complications were classified according to The Clavien-Dindo Classification of Surgical Complications. Categorical variables were compared using chi-square test. P Value was generated from chi-square score.

Results: The rate of complications in the geriatric group was 32% (n=15). 73% of them were ranked grade 1 and 27% grade 2 according to Clavien-Dindo Classification. In the non-geriatric group the rate of complications was 9% (n=4). 75% of them were ranked as grade 1, and only 1 patient had an intraoperative complication grade 2. The difference of complication rates between two groups was significant (p<0.001). There was no significant correlation between ASA-score, BMI, anticoagulants etc. and rate of complications in our study. Significantly more analgetics and corticosteroids postoperatively were applied in the geriatric group (p<0,01).

Conclusion: Patients with geriatric multimorbidity and polypharmacy who undergo surgery of lumbar stenosis have a significantly higher rate of complications. The absolute majority of these complications are minor complications (grade 1 and 2).