Early Postoperative Mortality and Morbidity Following Elective Spine Surgery in Patients Over 80 Years of Age

Study Design: Systematic review and meta-analysis. Objective: To systematically evaluate early postoperative morbidity and mortality after elective spine surgery in patients aged 80 years or older, and to critically appraise the adequacy and limitations of the current evidence to inform surgical risk stratification and patient counseling in this high-risk population. Summary of Background Data: The population aged 80 years or older is rapidly increasing, accompanied by rising demand for surgical management of degenerative spinal disease. Reported morbidity and mortality outcomes after elective spine surgery in this group vary widely, limiting accurate risk estimation. Improved evidence synthesis is needed to inform counseling and guide surgical decision-making. Methods: A comprehensive search of MEDLINE, Embase, and CINAHL identified studies published between 1996 and 2024 reporting patients aged 80 years or older undergoing elective spine surgery. Data on survival, complications, and comorbidities were extracted. Methodological quality was assessed with the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed where feasible. Results: Twelve studies encompassing 89,529 patients met the inclusion criteria. Pooled 30-day survival was high (98%, 95% CI: 94–99), though estimates varied across studies. Complications were frequent: the pooled overall rate was 16.0%, increasing to 21.8% unweighted. Major complications occurred in 5% to 10% of patients and minor complications in 8% to 10%. Studies enrolled relatively healthy older adults (ASA II–III), yet even in this select group, morbidity remained substantial. Reporting was inconsistent, with half of the studies providing major complication data and one-third reporting minor complications, underscoring gaps in the literature. Conclusion: Elective spine surgery in selected octogenarians shows excellent short-term survival but carries clinically meaningful complication rates. Current evidence largely reflects outcomes in the healthiest older adults, suggesting these results represent a best-case scenario. Despite increasing demand, high-quality, standardized data are lacking, limiting our ability to provide evidence-based counseling and prepare health systems for the growing burden of spine disease in an aging population.