Safety of Combined Anterior and Posterior Fusion in the Elderly Population

Study Design. Multi-surgeon, single institution retrospective observational cohort. Objectives. Compare complications, and outcomes between patients less than 70 years (<70Y) and ≥70 years (≥70Y) undergoing antero-posterior lumbar fusion. Summary of Background Data. Safety of antero-posterior lumbar fusion surgery in elderly patients remains debated, with concerns about increased perioperative risk and poorer outcomes. Methods. Patients undergoing short-segment antero-posterior lumbar fusion for degenerative indications were identified. Standard demographics, surgical data, complications (in-hospital, 30-, 90- and 365 d post-operative) and revisions after the index procedure were collected and compared between propensity-matched patients ≥70Y and <70Y. Results. After propensity score matching, 83 patients were included in each cohort for a total of 166 patients with similar sex distribution, body mass index, ASA ( P =0.347), smoking status and proportion of revision surgeries and number of levels fused. Surgical time and and estimated blood were similar between the two cohorts. Non-home discharge was significantly more frequent in the older cohort (33% vs. 10%, P =0.001). There was no difference in overall complication rates or at any individual interval: in-hospital, 30-day, 90-day and one year. Conclusions. In a propensity-matched cohort undergoing anterior-posterior lumbar fusion, elderly patients had similar intraoperative, 30-day, 90-day and one-year complications and length of hospitalization, suggesting baseline co-morbidity burden rather than age alone may account for much of the observed excess risk. Age alone should not preclude consideration of circumferential fusion when clinically indicated.