老年和八旬患者单节段前路腰椎椎体间融合术的术后并发症、住院时间和出院处置

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-08-07 DOI:10.1016/j.jor.2025.08.002

Paul G. Mastrokostas , Leonidas E. Mastrokostas , Aaron B. Lavi , Abigail Razi , John K. Houten , Ahmed Saleh , Jad Bou Monsef , Afshin E. Razi , Mitchell K. Ng

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引用次数: 0

摘要

前路腰椎椎体间融合术（ALIF）已成为一种被广泛接受的治疗退行性腰椎病变的方法，由于其在恢复腰椎前凸和改善脊柱平衡方面的有效性，其患病率越来越高。本研究旨在评估不同年龄组ALIF术后并发症、住院时间（LOS）和出院处置。方法2016 - 2020年，全国住院患者样本（NIS）共92800例50岁及以上的加权患者接受单水平ALIF治疗。患者按年龄分组（50-64岁，65-79岁，80岁以上）。排除非选择性病例和缺少关键变量数据。主要结局包括术后并发症（贫血、DVT、心肌梗死、中风、急性肾损伤、败血症、麻醉相关并发症）、LOS和出院处置。各年龄组间的统计比较采用Bonferroni校正的卡方检验。P <；0.005.结果研究发现不同年龄组的结果存在显著差异。平均年龄差异有统计学意义(P <；0.001)。老年患者的合并症和并发症发生率较高，急性出血性贫血在65-79岁组中最为常见（16.78%），败血症在80岁以上组中更为常见（0.90%）。LOS随年龄增长而增加(P <；总收费以65 ~ 79岁年龄组最高（P = 0.004）。常规出院率随年龄增长而显著下降，而非常规出院率随年龄增长而增加(P <；0.001)。结论年龄明显影响ALIF术后的预后。65岁及以上的患者出现各种并发症、住院时间延长和非常规出院的风险增加。这些研究结果强调需要量身定制围手术期护理和健全的出院计划，以改善老年ALIF患者的预后。与所有回顾性数据库研究一样，这种分析受到潜在的编码不准确性和NIS中缺乏详细临床细节的限制。

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Postoperative complications, length of stay, and discharge disposition following single-level anterior lumbar interbody fusion in elderly and octogenarian patients

Background

Anterior lumbar interbody fusion (ALIF) has become a widely accepted treatment for degenerative lumbar spine pathologies, with increasing prevalence due to its effectiveness in restoring lumbar lordosis and improving spinal balance. This study aims to evaluate postoperative complications, length of stay (LOS), and discharge disposition following ALIF across different age groups.

Methods

A total of 92,800 weighted cases of patients aged 50 and older underwent single-level ALIF in the National Inpatient Sample (NIS) from 2016 to 2020. Patients were stratified into age cohorts (50–64, 65–79, 80+). Exclusions were made for non-elective cases and missing data on key variables. Primary outcomes included postoperative complications (anemia, DVT, myocardial infarction, stroke, acute kidney injury, sepsis, anesthesia-related complications), LOS, and discharge disposition. Statistical comparisons between age groups were conducted using chi-square tests with a Bonferroni correction. Significance was set at P < 0.005.

Results

The study identified significant variations in outcomes across age groups. The mean age differed significantly (P < 0.001). Older patients had higher rates of comorbidities and complications, with acute post-hemorrhagic anemia being most prevalent in the 65–79 group (16.78 %) and sepsis more common in the 80+ group (0.90 %). The LOS increased with age (P < 0.001), and total admission charges were highest in the 65–79 age group (P = 0.004). Routine discharge rates decreased significantly with age, while non-routine discharges increased (P < 0.001).

Conclusion

Age significantly influences postoperative outcomes following ALIF. Patients aged 65 and older are at increased risk for various complications, longer hospital stays, and non-routine discharges. These findings highlight the need for tailored perioperative care and robust discharge planning to improve outcomes for elderly patients undergoing ALIF. As with all retrospective database studies, this analysis is limited by potential coding inaccuracies and the absence of granular clinical details within the NIS.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.