gms | German Medical Science

Objective: Increasing incidence of aged 80 or older patients with degenerative spine disease, rising comorbidities and oral anticoagulants (OAK) are the result of an increasing demographic aging of general population. We therefore evaluate the risk of lumbar decompression surgery and management of OAK-therapy in aged 80 or older patients in regard to clinical outcome and complications.

Method: All patients aged 80 or older in period from 1/2013 to 6/2015 with lumbar decompression surgery by hemi-laminectomy in our institution were reviewed retrospectively. Age, gender, co-morbidities, sort of OAK, coagulation tests, neurostatus, intra-/postoperative complications, surgery-time and -procedure, postoperative care unit (PACU)- and hospital-stay overall as well as patients outcome were assessed. Two groups – patients with OAK (group 1) and patients without OAK (group 2) – were formed.

Results: In total 42 patients (m: 18, f: 24) with mean age of 82.5 (range 80-87) could identified. In group 1 (m: 10, f: 12; mean age 82,6) 86% of patients received single- (platelet inhibition or vitamin K antagonist) and 14% dual-OAK therapy (platelet inhibition plus vitamin K antagonist) paused 7 days (min. 5, max. 10) before hospital admission. In 4 (18%) coagulation tests (Quick/INR value, PFA100, Born-test) abnormalities were found. Mean number of co-morbidities was 4.6 (min. 1, max. 10). Decompression surgery was performed in 64% of level-1-, 23% level-2- and 13% level-3-stenoses. Complications were intraoperative dural leaks (n=4) and postoperative haematoma with wound infection, re-surgery and patient’s death (n=1). 10 patients were observed for 1 day at PACU. After mean hospital stay of 10.2 days 86% (19) patients were with improvement of complaints discharged at home. In group 2 (m: 8, f: 12; mean age 82.5) mean number of co-morbidities was 2.7 (min. 0, max. 6). In 65% 1 level-, 20% 2 level- and 15% 3 level-decompression surgeries were performed. 1 dural leak appeared intraoperatively and 1 case of postoperative ISG-syndrome occurred. The mean hospital stay was 8.8 days. All patients reported about improvement after surgery and 90% (18) could be discharged at home.

Conclusions: The vast majority of patients aged 80 or older with and without OAK and high number of comorbidities profit from lumbar decompression surgery. However consideration of OAK therapy and comorbidities remains important for hospital treatment and surgical indication to avoid unnecessary complications and longer hospital stays.