Age, Racial, and Socioeconomic Impact on Surgical Outcomes in Octogenarian vs. Non-Octogenarian Patients Undergoing Lumbar Spine Surgery: A National Database Analysis from 2012 to 2020

Introduction: Managing elderly patients during spinal surgeries is particularly challenging due to their unique physiological responses and prevalent comorbidities. This study evaluates the surgical outcomes of octogenarian patients undergoing lumbar surgery, and investigates disparities in demographics, surgical approaches, and postoperative outcomes.

Methods: Data from the National Surgical Quality Improvement Program (NSQIP) for the years 2012 to 2020 were analyzed. The study included 88,381 patients, stratified into octogenarian and non-octogenarian groups. These groups were further analyzed based on race/ethnicity, type of surgical approach, admission source, and discharge outcomes. Statistical analyses assessed the impact of these factors on postoperative length of stay, complication rates, and readmission. Propensity score matching (1:1) was performed.

Results: In this study of 100,686 patients with degenerative spine disease (96,011 non-octogenarians; 4,675 octogenarians), notable differences in demographics, surgical approaches, and outcomes were observed. The octogenarian group had a higher proportion of Asian, White, and Hispanic patients and more commonly underwent the oblique surgical approach (68.9% vs. 63.7%), while non-octogenarians more frequently received anterior or posterior approaches. Octogenarians exhibited poorer preoperative functional status, with a higher percentage classified as ASA Class 3 or 4, greater rates of partial (5.2% vs. 1.9%) or total dependency (0.3% vs. 0.1%), and were more likely to receive non-general anesthesia (0.6% vs. 0.3%) and non-elective surgery. Octogenarians also had shorter operative times, longer hospital stays, and lower discharge rates to home (53.5% vs. 83.9%). Postoperative complications were significantly higher in octogenarians, with increased rates of pneumonia, unplanned intubation, renal failure, urinary tract infections, myocardial infarction, bleeding, and mortality. Readmission was also more common among octogenarians. Predictors for complications included the oblique approach, hypertension, and history of wound infection, while male sex was associated with lower complication odds. Diabetes, disseminated cancer, and steroid use were linked to higher readmission odds. Octogenarians showed an increasing trend toward non-general anesthesia lumbar fusion, though there was no significant trend in readmission or reoperation rates.

Conclusion : Our study highlights the pronounced disparities in surgical outcomes between octogenarian and non-octogenarian patients undergoing lumbar spine surgery. The findings underscore the necessity for tailored clinical strategies to accommodate the complex healthcare needs of the elderly.