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 CME 4: October, November, December 2003
Spine Test 2: Perioperative Care
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The Journal of Bone and Joint Surgery (American) 85:2089-2092 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Perioperative Complications of Posterior Lumbar Decompression and Arthrodesis in Older Adults

Leah Y. Carreon, MD1, Rolando M. Puno, MD1, John R. Dimar, II, MD1, Steven D. Glassman, MD1 and John R. Johnson, MD1

1 Kenton D. Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202. E-mail address for L.Y. Carreon: lcarreon{at}spinemds.com

Investigation performed at Norton Hospital, Louisville, Kentucky

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Norton Healthcare. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. R.M.P., J.R.D. II, S.D.G., and J.R.J. acknowledge a financial relationship (consultants for and royalties from Medtronic Sofamore Danek), which may indirectly relate to the subject of this research.

Background: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at increased risk for complications because of their age and associated medical conditions. In this study, we examined the rates of perioperative complications associated with posterior lumbar decompression and arthrodesis in patients sixty-five years of age or older.

Methods: We reviewed the hospital records of ninety-eight patients who were sixty-five years of age or older when they had a posterior decompression and lumbar arthrodesis with instrumentation, between 1993 and 1995, to treat degenerative disease of the spine. The average age was seventy-two years (range, sixty-five to eighty-four years).

Results: Perioperative complications occurred in seventy-eight patients. Twenty-one patients had at least one major complication, and sixty-nine had at least one minor complication. Forty-nine patients had more than one complication. The most common major complication was wound infection (prevalence, 10%), and the most common minor complication was urinary tract infection (prevalence, 34%). The complication rate increased with older age, increased blood loss, longer operative time, and the number of levels of the arthrodesis.

Conclusions: Surgeons should be vigilant about perioperative complications in elderly patients treated with multi-level lumbar decompression and arthrodesis with instrumentation. Elderly patients should be made aware that they are at increased risk for surgical complications because of their age. Attention should be paid to controlling blood loss and limiting operative time.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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