Impact 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

doi:10.1016/j.wneu.2018.05.185

World Neurosurgery

Volume 116, August 2018, Pages e1122-e1128

https://doi.org/10.1016/j.wneu.2018.05.185 Get rights and content

Highlights

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Retrospective study of elderly patients with COPD undergoing spinal fusion.
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Higher rate of postoperative fever and pneumonia in COPD patients versus non-COPD patients.
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Non-COPD patients were able to ambulate further on first postoperative ambulation day versus COPD patients.
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COPD patients had longer hospital stay versus non-COPD patients.
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COPD is a modifiable risk factor for increased health care utilization after fusion.

Objective

To investigate the impact that chronic obstructive pulmonary disease (COPD) has on postoperative complication rates, ambulation, and hospital length of stay for elderly spinal deformity patients after elective spinal fusion (≥3 levels).

Methods

The medical records of 559 elderly (≥60 years old) spine deformity patients undergoing elective spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 60 patients with COPD (10.7%) and 499 patients without COPD (89.3%). Patient demographics, comorbidities, postoperative complications, ambulatory status, and readmission rates were collected. The primary outcomes investigated in this study were complication rates and length of hospital stay.

Results

Demographics and comorbidities were similar between groups, with a difference in proportion of smokers (COPD group: 25.0% vs. no COPD group: 9.6%, P = 0.0004). The median number of fusion levels (P = 0.840), operative time (P = 0.842), estimated blood loss (P = 0.336), and incidences of durotomy (P = 0.258) was similar between both cohorts. The COPD cohort experienced a higher rate of postoperative fever (10.0% vs. 3.0%, P = 0.007) and pneumonia (5.0% vs. 0.4%, P = 0.0004), respectively. There was a significant difference in the number of feet walked on the first day of ambulation after surgery (COPD group: 58.6 ± 78.4 vs. no COPD group: 84.0 ± 102.8, P = 0.040). Length of hospital stay was significantly longer in the COPD cohort than the no COPD cohort (7.7 ± 6.4 vs. 6.0 ± 4.0 days, respectively; P = 0.0498).

Conclusions

Our study demonstrates that elderly patients with COPD have increased lengths of stay and higher rates of postoperative pneumonia after spinal fusion. This determination identifies a potentially modifiable risk factor for increased utilization of health care resources.

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.

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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

Highlights

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Materials and Methods

Patient Demographics and Preoperative Variables

Discussion

Conclusions

Spine Deform

World Neurosurg

Lancet

Respir Med

Chest

J Vasc Surg

Spine J

Spine J

J Orthop Surg Res

Spine J

World Neurosurg

J Arthroplasty

Mayo Clin Proc

J Surg Res

Ann Thorac Surg

Surg Clin North Am

Am J Surg

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

Eur Spine J

An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations

J Am Geriatr Soc

Trends and variations in the use of spine surgery

Clin Orthop Relat Res

Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults

JAMA

Low back pain hospitalization. Recent United States trends and regional variations

Spine (Phila Pa 1976)

Original Article
Impact 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