Original ArticleImpact of Chronic Obstructive Pulmonary Disease on Postoperative Complication Rates, Ambulation, and Length of Hospital Stay After Elective Spinal Fusion (≥3 Levels) in Elderly Spine Deformity Patients
Introduction
Nationally, there has been a growing shift in the proportion of geriatric patients experiencing spinal disorders and undergoing elective spinal surgery.1, 2, 3, 4, 5, 6, 7, 8 Spinal deformity is one of the fastest-growing diagnoses in the elderly population, with an estimate of >60 million elderly adults being diagnosed with some degree of spinal deformity by year 2050.9 Because of the physiologic changes of aging, geriatric patients are at increased risk for comorbidities that may have significant implications on perioperative complications after complex spine surgery.10
Chronic obstructive pulmonary disease (COPD) is estimated to be the third leading cause of death by 2020 and has been strongly associated with poor postoperative outcomes in the elderly population.11, 12, 13, 14 In fact, the prevalence of COPD is higher among surgical candidates than age-matched comparisons in the general population15 and has been linked with an increased risk of morbidity, mortality, and length of hospital stay after general surgery,16, 17 vascular surgery,18 and orthopedic surgery.19, 20 Moreover, there have been a few studies that have found significant associations between COPD and higher complication and mortality rates after spine surgery.4, 21, 22 However, there is a paucity of data identifying the impact that COPD has on surgical outcomes in elderly patients undergoing elective spine surgery.
The aim of this study is to investigate the impact of COPD on postoperative complication rates, ambulation, and length of hospital stay for elderly spine deformity patients after elective spinal fusion (≥3 levels).
Section snippets
Materials and Methods
The medical records of 559 elderly (≥60 years old) deformity patients undergoing elective spinal fusion at a major academic institution from 2005 to 2015 were retrospectively reviewed. Institutional review board approval was obtained prior to study initiation. Patients were categorized based on preoperative diagnosis of COPD. We identified 60 elderly patients with COPD (10.7%) and 499 patients without COPD (89.3%). The primary outcome investigated in this study was perioperative complication
Patient Demographics and Preoperative Variables
There were 559 elderly patients (≥60 years old) included in this study (no COPD group: n = 499; COPD group: n = 60) (Table 1). There were no significant differences in age (no COPD group: 69.9 ± 6.1 vs. COPD group: 68.9 ± 4.8 years, P = 0.131) or proportion of women (no COPD group: 62.1% vs. COPD group: 63.3%, P = 0.846) between both cohorts (Table 1). There was no significant difference in body mass index observed between cohorts (no COPD group: 28.2 ± 6.0 vs. COPD group: 29.5 ± 6.4 kg/m2, P =
Discussion
In this retrospective study of elderly deformity patients undergoing elective spine surgery (≥3 levels), we demonstrate that patients with preoperative diagnosis of COPD have significantly increased lengths of stay, decreased ambulation, and higher rates of postoperative pneumonia.
In an era of shifting emphasis on preoperative identification of at-risk surgical patients, studies have associated COPD with increased postoperative complications and length of hospital stay after spine surgery. In a
Conclusions
Our study demonstrates that elderly patients with COPD have increased lengths of stay, delayed ambulation, and higher rates of pneumonia in the postoperative setting after elective spinal fusion (≥3 levels). This risk determination identifies a potentially modifiable risk factor for increased health care utilization after spine surgery.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.