Lumbar Decompression versus Decompression and Fusion in Octogenarians: Complications and Clinical Course With 3-Year Follow-Up

Study Design Retrospective review. Objectives This study aimed to assess and compare the clinical course and complications between surgical decompression and decompression with fusion in lumbar spine patients aged >= 80 years. Methods A retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2021. Logistic regression was used to identify potential risk factors for the occurrence of complications. Results Over a 16-year period, 327 patients were allocated to the decompression only group and 89 patients were allocated to the decompression and instrumented fusion group. The study had a mean follow-up duration of 36.7 +/- 12.4 months. When assessing the CCI, patients of the instrumentation group had fewer comorbidities (8.9 +/- .5 points vs 6.2 +/- 1.5 points; P < .001), significantly longer surgical duration (290 +/- 106 minutes vs 145 +/- 50.2 minutes; P < .001), significantly higher volume of intraoperative blood loss (791 +/- 319.3 ml vs 336.1 +/- 150.8 ml; P < .001), more frequent intraoperative blood transfusion (7 +/- 2.1% vs 16 +/- 18.0%; P < .001), and extended stays in the intensive care unit and hospitalization rates. Logistic regression analysis revealed that surgical duration and extent of surgery were unique risk factors for the occurrence of complications. Conclusions Lumbar decompression and additional fusion in octogenarians are considerable treatment techniques; albeit associated with increased complication risks. Prolonged operative time and extent of surgery are critical confounding factors associated with higher rates of postoperative complications. Surgery should only be performed after careful outweighing of potential benefits and risks.