Clinical Outcomes, Complications, and Cost-effectiveness in Surgically Treated Adult Spinal Deformity Over 70 Years: A Propensity score-Matched Analysis.

ABSTRACT

STUDY DESIGN: This is a multicentered retrospective study. SUMMARY OF BACKGROUND DATA Surgical correction for the adult spinal deformity (ASD) is effective but carries substantial risks for complications. The diverse pathologies of ASD make it difficult to determine the effect of advanced age on outcomes. OBJECTIVE: The objective of this study was to assess how advanced age affects outcomes and cost-effectiveness for corrective surgery for ASD. MATERIALS AND METHODS: We used data from a multicenter database to conduct propensity score-matched comparisons of 50 patients who were surgically treated for ASD when at least 50 years old and were followed for at least 2 years, to clarify whether advanced age is a risk factor for inferior health-related quality of life and cost-effectiveness. Patients were grouped by age, 50-65 years (M group 59±4 y) or >70 years (O group 74±3 y), and were propensity score-matched for sex, body mass index, upper and lower instrumented vertebrae, the use of pedicle-subtraction osteotomy, and sagittal alignment. Cost-effectiveness was determined by cost/quality-adjusted life years. RESULTS: Oswestry Disability Index and Scoliosis Research Society-22 (SRS-22) pain and self-image at the 2-year follow-up were significantly inferior in the O group (Oswestry Disability Index 32±9% vs. 25±13%, P=0.01; SRS-22 pain 3.5±0.7 vs. 3.9±0.6, P=0.05; SRS-22 self-image 3.5±0.6 vs. 3.8±0.9, P=0.03). The O group had more complications than the M group (55% vs. 29%). The odds ratios in the O group were 4.0 for postoperative complications (95% confidence interval 1.1-12.3) and 4.9 for implant-related complications (95% confidence interval 1.2-21.1). Cost-utility analysis at 2 years after surgery indicated that the surgery was less cost-effective in the O group (cost/quality-adjusted life year O group $211,636 vs. M group 125,887, P=0.01). CONCLUSIONS: Outcomes for corrective surgery for ASD were inferior in geriatric patients compared with middle-aged patients, in whom the extent of spinal deformity and the operation type were adjusted similarly. Special attention is needed when considering surgical treatment for geriatric ASD patients.