Elderly as a Predictor for Perioperative Complications in Patients Undergoing Multi-level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Regression Modeling Study.

Abstract

STUDY DESIGN\nThis was a single-institute retrospective study OBJECTIVE.: To describe perioperative and postoperative complications in elderly who underwent multi-level MIS TLIF while identifying predictors of complications.\n\n\nSUMMARY OF BACKGROUND DATA\nThe number of elderly patients undergoing spinal fusion is rising. Spinal surgery in the elderly is considered high risk with high rates of complications. However, perioperative and postoperative complications in elderly undergoing multi-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is not known.\n\n\nMETHODS\nA retrospective analysis was performed on 467 consecutive patients who underwent multi-level MIS TLIF at a single institution from 2013 to 2017. Two cohorts, 70 years or older and 50-69 years old were analyzed. Multiple logistic regressions with minor and major complication rates as the dependent variables were performed to identify predictors for complication based on previously sited risk factors. A p-value of ≤0.025 was considered significant.\n\n\nRESULTS\nOne-hundred-fifty-two elderly and 315 non-elderly patients underwent multi-level MIS TLIFs. The average age was 76.4 years and 60.4 years for the elderly and non-elderly cohorts. We observed 13 major (8.44%) and 72 minor (47.4%) complications in the elderly. No difference was noted in complication between the cohorts, except for UTI (p\u200a=\u200a.004) and urinary retention (p\u200a=\u200a.014). There were no myocardial infarctions, hardware complications, visceral, vascular, neural injuries, or death. Length of stay, comorbidity, and length of surgery of were predictive of major and minor complications.\n\n\nCONCLUSIONS\nElderly may undergo multi-level MIS TLIF with comparable complication rates. Age was not a predictor of complications. Rather, attention should focus on evaluation of comorbidity and limiting operative times.\n\n\nLEVEL OF EVIDENCE\n3.