Cervical Spine Surgery Complications and Risks in the Elderly

Study Design. Cervical decompression (CD) and cervical fusion (CF) patients in 5% Medicare Part B claims data. Objective. Evaluate the complication rate and associated risk factors after cervical spine surgery using a national sample of elderly patients. Summary of Background Data. The number of cervical spine procedures in the United States has risen along with associated hospital costs. Postoperative complications lead to longer hospitalizations and greater costs. Methods. Demographic information and postoperative complications (90 days) were evaluated. Multivariate Cox regression was used to evaluate the risk factors for the complications, while adjusting for age, socioeconomic status, Charlson comorbidity index, race, census region, sex, and year of surgery. Results. Between 2010 and 2012, 1519 CD and 1273 CF Medicare patients were identified in the dataset. Respiratory complications (CD: 12.1% and CF: 14.6%), urinary retention (CD: 8.2% and CF: 9.1%), acute delirium (CD: 5.3% and CF: 6.0%), and nausea/vomiting (CD: 2.8% and CF: 3.1%) were the most commonly diagnosed complications. All other complications had an incidence of less than 1.5%. Older patients had higher risks of respiratory complications for both procedures, and CD patients with Charlson scores of 1 to 2 and 5+ were also at higher risk of respiratory complications. Males (P < 0.001) were at higher risk of urinary retention. Patients with dementia (P < 0.001) had a higher risk of acute delirium after both CD and CF. For CD patients, those aged 85 years and over had higher risk of acute delirium, along with patients with transient ischemic attack/stroke. Age was also a significant risk factor (P=0.019) for acute delirium for CF patients. Females were at a significantly higher risk of nausea/vomiting after CD and CF. Conclusion. These data help to provide baseline information regarding the complication rates in the elderly CD and CF patient population in the United States, and will serve to help minimize these complications.