Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University Baltimore, MD, US
Introduction: Octogenarians undergoing spinal surgery face heightened risks due to physiological frailty and the high prevalence of comorbid conditions. As surgical techniques evolve, it is critical to assess which methods best suit this vulnerable age group. This retrospective study compares the outcomes of endoscopic and open spine surgeries in octogenarians, focusing on assessing the relative benefits of these techniques in terms of safety and efficacy.
Methods: Data from the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2017 to 2022 were analyzed, involving 48,787 spinal procedures on octogenarians, including 113 endoscopic and 48,674 open surgeries. Propensity score matching was used to equalize baseline characteristics between the groups. The primary outcome was the comparison of postoperative outcomes, including adverse outcomes, operative duration, and patient discharge status. Logistic regression was employed to evaluate the effects of surgical type, operative duration, and patient demographics on postoperative outcomes.
Results: Our study revealed that endoscopic surgery resulted in significantly better outcomes, including lower odds of adverse outcomes (OR = -0.75, p < 0.001), reduced operative times, and fewer postoperative complications. Patients in the endoscopic group were also more likely to be discharged directly to their homes and utilized non-general anesthesia more frequently. The presence of racial disparities and higher ASA classifications were significantly associated with worse outcomes, emphasizing the need for individualized preoperative evaluations. From 2017 to 2022, the annual number of endoscopic procedures rose from 9 to 44, with outpatient procedures increasing from 22.2% to 77.3% and the use of non-general anesthesia jumping from 0% to 50%. In contrast, open surgeries saw slight improvements, with outpatient procedures increasing from 50.2% to 59.1% and home discharge rates improving from 86% to 90%. The use of general anesthesia remained high at approximately 99% in open surgeries.
Conclusion : The findings show that endoscopic procedures for spinal disease in octogenarians result in better surgical outcomes, reduced length of stay (LOS) and operative time, and can be safely performed. These findings suggest that transitioning towards minimally invasive approaches in this high-risk population should be considered.
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