How to Improve Outcomes of Spine Surgery in Geriatric Patients.
Aged
Aged, 80 and over
Comorbidity
Decompression, Surgical
Delirium
/ epidemiology
Disease Progression
Enhanced Recovery After Surgery
Frailty
/ epidemiology
Humans
Minimally Invasive Surgical Procedures
Neurosurgical Procedures
/ methods
Orthopedic Procedures
/ methods
Osteoporosis
/ epidemiology
Outcome Assessment, Health Care
Pain Management
Postoperative Care
Postoperative Complications
/ epidemiology
Spinal Curvatures
/ epidemiology
Spinal Diseases
/ epidemiology
Spinal Fusion
Frailty index
Geriatrics
Osteoporosis
Spine surgery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
20
03
2020
revised:
07
04
2020
accepted:
09
04
2020
entrez:
17
8
2020
pubmed:
17
8
2020
medline:
17
12
2020
Statut:
ppublish
Résumé
The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. A literature search of the last 10 years was done. Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium. Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
Sections du résumé
BACKGROUND
The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery.
METHODS
A literature search of the last 10 years was done.
RESULTS
Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium.
CONCLUSIONS
Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
Identifiants
pubmed: 32797984
pii: S1878-8750(20)30767-1
doi: 10.1016/j.wneu.2020.04.060
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
519-526Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.