The impact of advanced age on perioperative outcomes in
surgical treatment of cervical spondylotic myelopathy:
A nationwide study between 2001 and 2010
Jalai CM, Worley N, Marascalchi BJ, Challier V, Vira S, Yang S, Boniello AJ,Bendo JA, Lafage
V, Passias PG
Spine. 2016;41: E139-147. PubMed ID: 26866740. Available at: https://www.ncbi.nlm.nih.gov/
STUDY DESIGN: Retrospective multicenter database review.
OBJECTIVE: The aim of this study was to evaluate national postoperative outcomes and hospital
characteristics trends from 2001 to 2010 for advanced age CSM patients.
SUMMARY OF BACKGROUND DATA: Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger
METHODS: A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM
patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures,
9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and
hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and
logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age
groups (OR[95% CI]).
RESULTS: Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+
years were identified. Average comorbidity indices for patients at 65+ years were higher compared to
the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate ( 11.39%
vs. 5.93%, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged
65+ patients was longer ( 4.76 vs. 3. 26 days, P<0.0001). Mortality risk was higher in the 65+ cohort
( 3. 38[ 2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except
device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed
increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses ( 5.77 vs. 4. 28 days,
P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with
increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate ( 13.87% vs.
10.20%, P< 0.001), and displayed increased risk for postoperative shock ( 6. 34 [ 11. 16-3.60], P <0.001),
digestive system ( 1.92 [ 2. 40-1.54], P<0.001), and wound dehiscence ( 1.71 [ 2.56-1.15], P<0.001).
CONCLUSION: Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course,
and higher charges. This study provides clinically useful data for surgeons to educate patients and
to improve outcomes.
Reprinted with permission.
Jalai et al conducted a large, retrospective national database review of patients with
surgically treated cervical spondylotic myelopathy (CSM). The authors sought to evaluate the impact of advanced age on in-hospital outcomes after anterior and/or posterior
cervical spine fusion or laminoplasty in this population. This study utilized patients in
the Nationwide Inpatient Sample (NIS) database, which is the largest all-payer database
available in the US. This is an administratively coded database that tracks patients during
Benjamin J. Geddes, MD,
Jonathan N. Grauer, MD
Department of Orthopaedics and
Rehabilitation, Yale University
School of Medicine
New Haven, CT