Primary Malignancy is an Independent Determinant of Morbidity and Mortality after Liver Resection

2017 ◽  
Vol 83 (5) ◽  
pp. 436-444 ◽  
Author(s):  
Marc W. Fromer ◽  
John P. Gaughan ◽  
Umur M. Atabek ◽  
Francis R. Spitz
Keyword(s):  
Liver Resection ◽  
Primary Liver Cancer ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
National Database ◽  
Matched Pair ◽  
Fisher Exact Test ◽  
Improvement Program ◽  
Risk Of Death ◽  
Liver Cancers

Although outcomes after liver resection have improved, there remains considerable perioperative morbidity and mortality with these procedures. Studies suggest a primary liver cancer diagnosis is associated with poorer outcomes, but the extent to which this is attributable to a higher degree of hepatic dysfunction is unclear. To better delineate this, we performed a matched pair analysis of primary versus metastatic malignancies using a national database. The American College of Surgeons National Surgical Quality Improvement Program (2005–2013) was analyzed to select elective liver resections. Diagnoses were sorted as follows: 1) primary liver cancers and 2) metastatic neoplasms. A literature review identified factors known to impact hepatectomy outcomes; these variables were evaluated by a univariate analysis. The most predictive factors were used to create similar groups from each diagnosis category via propensity matching. Multivariate regression was used to validate results in the wider study population. Outcomes were compared using chi-squared test and Fisher exact test. Matched groups of 4838 patients were similar by all variables, including indicators of liver function. A number of major complications were significantly more prevalent with a primary diagnosis; overall major morbidity rates in the metastatic and primary groups were 29.3 versus 41.6 per cent, respectively. The mortality rate for primary neoplasms was 4.6 per cent (vs 1.6%); this represents a risk of death nearly three-times greater (95% confidence interval = 2.20–3.81, P < 0.0001) in cancers of hepatic origin. Hepatectomy carries substantially higher perioperative risk when performed for primary liver cancers, independent of hepatic function and resection extent. This knowledge will help to improve treatment planning, patient education, and resource allocation in oncologic liver resection.

Endovascular Therapy for Acute Mesenteric Ischemia: An NSQIP Analysis

2015 ◽  
Vol 81 (11) ◽  
pp. 1170-1176 ◽  
Author(s):  
Bernardino C. Branco ◽  
Miguel F. Montero-Baker ◽  
Hassan Aziz ◽  
Zachary Taylor ◽  
Joseph L. Mills
Keyword(s):  
Endovascular Therapy ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Improvement Program ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Emergency Surgical Intervention ◽  
The Impact

Acute mesenteric ischemia (AMI) continues to carry high morbidity and mortality. Endovascular strategies have been increasingly used in the management of AMI. The purpose of this study was to evaluate the impact of endovascular therapy on outcomes of patients with AMI. The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency surgical intervention for AMI. Demographics, clinical data, interventions, and outcomes were extracted. Patients were compared according to treatment (endovascular versus hybrid versus open revascularization). Over the six-year study period, a total of 439 patients were found to have AMI [27 (6.2%) endovascular, 23 (5.2%) hybrid, and 389 (88.6%) open revascularization]. A total of 16 (59.3%) patients in the endovascular group avoided laparotomy. There was a trend toward lower transfusion requirements (intraoperative transfusion: 3.7% for endovascular vs 17.4% for hybrid vs 19.3% for open, adjusted. P = 0.127) and complications in particular pneumonia (22.2% vs 39.1% vs 27.8%, respectively, Adj. P = 0.392) and sepsis (25.9% vs 21.7% vs 35.5%, adjusted P = 0.260). Endovascular therapy was associated with a 2.5-fold decrease in the risk of death [odds ratio, 95% confidence interval: 0.4 (0.2, 0.9), adjusted P = 0.018]. In this analysis of morbidity and mortality, endovascular therapy was associated with decreased need for laparotomy and a trend toward lower transfusion requirements and complications, in particular pneumonia and sepsis. Endovascular first therapy was associated with a 2.5-fold decrease in the risk of death. Further prospective evaluation of these results is warranted.

scholarly journals Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011

2014 ◽  
Vol 120 (3) ◽  
pp. 736-745 ◽  
Author(s):  
John D. Rolston ◽  
Seunggu J. Han ◽  
Catherine Y. Lau ◽  
Mitchel S. Berger ◽  
Andrew T. Parsa
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
National Database ◽  
Improvement Program ◽  
Chi Square ◽  
Surgical Specialty ◽  
Starting Point ◽  
Neurosurgical Patients ◽  
Us Government ◽  
Neurological Surgery

Object Surgical complications increase the cost of health care worldwide and directly contribute to patient morbidity and mortality. In an effort to mitigate morbidity and incentivize best practices, stakeholders such as health insurers and the US government are linking reimbursement to patient outcomes. In this study the authors analyzed a national database to determine basic metrics of how comorbidities specifically affect the subspecialty of neurosurgery. Methods Data on 1,777,035 patients for the years 2006–2011 were acquired from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery.” Univariate statistics were calculated using the chi-square test, and 95% confidence intervals were determined for the resultant risk ratios. A multivariate model was constructed using significant variables from the univariate analysis (p < 0.05) with binary logistic regression. Results Over 38,000 neurosurgical cases were analyzed, with complications occurring in 14.3%. Cranial cases were 2.6 times more likely to have complications than spine cases, and African Americans and Asians/Pacific Islanders were also at higher risk. The most frequent complications were bleeding requiring transfusion (4.5% of patients) and reoperation within 30 days of the initial operation (4.3% of patients), followed by failure to wean from mechanical ventilation postoperatively (2.5%). Significant predictors of complications included preoperative stroke, sepsis, blood transfusion, and chronic steroid use. Conclusions Understanding the landscape of neurosurgical complications will allow better targeting of the most costly and harmful complications of preventive measures. Data from the ACS NSQIP database provide a starting point for developing paradigms of improved care of neurosurgical patients.

scholarly journals Biofilm Production by Carbapenem-Resistant Klebsiella pneumoniae Significantly Increases the Risk of Death in Oncological Patients

2020 ◽  
Vol 10 ◽  
Author(s):  
Enea Gino Di Domenico ◽  
Ilaria Cavallo ◽  
Francesca Sivori ◽  
Francesco Marchesi ◽  
Grazia Prignano ◽  
...  
Keyword(s):  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Univariate Analysis ◽  
Carbapenem Resistance ◽  
Morbidity And Mortality ◽  
Risk Of Death ◽  
Carbapenem Resistant ◽  
Biofilm Production ◽  
Oncological Patients ◽  
The Impact

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a prominent cause of nosocomial infections associated with high rates of morbidity and mortality, particularly in oncological patients. The hypermucoviscous (HMV) phenotype and biofilm production are key factors for CRKP colonization and persistence in the host. This study aims at exploring the impact of CRKP virulence factors on morbidity and mortality in oncological patients. A total of 86 CRKP were collected between January 2015 and December 2019. Carbapenem resistance-associated genes, antibiotic susceptibility, the HMV phenotype, and biofilm production were evaluated. The median age of the patients was 71 years (range 40–96 years). Clinically infected patients were 53 (61.6%), while CRKP colonized individuals were 33 (38.4%). The most common infectious manifestations were sepsis (43.4%) and pneumonia (18.9%), while rectal surveillance swabs were the most common site of CRKP isolation (81.8%) in colonized patients. The leading mechanism of carbapenem resistance was sustained by the KPC gene (96.5%), followed by OXA-48 (2.3%) and VIM (1.2%). Phenotypic CRKP characterization indicated that 55.8% of the isolates were strong biofilm-producers equally distributed between infected (54.2%) and colonized (45.8%) patients. The HMV phenotype was found in 22.1% of the isolates, which showed a significant (P&lt;0.0001) decrease in biofilm production as compared to non-HMV strains. The overall mortality rate calculated on the group of infected patients was 35.8%. In univariate analysis, pneumoniae significantly correlated with death (OR 5.09; CI 95% 1.08–24.02; P=0.04). The non-HMV phenotype (OR 4.67; CI 95% 1.13–19.24; P=0.03) and strong biofilm-producing strains (OR 5.04; CI95% 1.39–18.25; P=0.01) were also associated with increased CRKP infection-related mortality. Notably, the multivariate analysis showed that infection with strong biofilm-producing CRKP was an independent predictor of mortality (OR 6.30; CI 95% 1.392–18.248; P=0.004). CRKP infection presents a high risk of death among oncological patients, particularly when pneumoniae and sepsis are present. In infected patients, the presence of strong biofilm-producing CRKP significantly increases the risk of death. Thus, the assessment of biofilm production may provide a key element in supporting the clinical management of high-risk oncological patients with CRKP infection.

The effect of recent chemotherapy in aorto-iliac aneurysm repair

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Nikolaos Tsilimparis ◽  
Joseph J Ricotta ◽  
Anand Dayama ◽  
James G Reeves ◽  
Sebastian Perez ◽  
...  
Keyword(s):  
Surgical Complications ◽  
Univariate Analysis ◽  
Iliac Aneurysm ◽  
Improvement Program ◽  
Risk Of Death ◽  
Elective Repair ◽  
Group A ◽  
Acs Nsqip Database ◽  
Group B ◽  
Aneurysm Repair

The aim of the study was to investigate the effect of recent chemotherapy (Chx) on outcome of aorto-iliac aneurysm (AAA) repair. The 2005–2010 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify vascular patients undergoing AAA repair within 30 days after Chx. Seventy-one patients underwent AAA repair within 30 days of receiving Chx, group A (71 ± 8.4 years, 77.5% males) and 20,024 patients underwent AAA repair without prior Chx, group B (73 ± 9 years, 79.2% males). The two groups did not significantly differ with respect to open or endovascular repair (open repair A: 32%, B: 35%, P = 0.66). However, patients in group A presented more often as emergent cases (A: 27%, B: 12%, P = 0.001). Multivariable regression analysis for emergent cases after adjustment for relevant confounders also demonstrated that patients with recent Chx present more often as emergency ( P = 0.001, odds ratio [OR]: 2.4). Thirty-day non-surgical complications were more common in group A (A: 25%, B: 16.5%, P = 0.046) while surgical complications were equivalent (A: 15.5%, B: 12.3%, P = 0.414). Risk of death was significantly higher in group A in univariate analysis (A: 13%, B: 5%, P = 0.005, OR: 2.6). Patients who receive Chx within 30 days prior to AAA repair present more frequently as emergencies leading to higher mortality. The reason for this cannot be sufficiently explained by the current database but patient selection for elective repair or the effect of Chx on the natural course of AAA may play a role.

Secondary Cleft Rhinoplasty in 1720 Patients: Are National Practices Consistent With Guidelines?

2019 ◽  
Vol 57 (4) ◽  
pp. 438-443
Author(s):  
Fouad Chouairi ◽  
Sina J. Torabi ◽  
Kyle S. Gabrick ◽  
John A. Persing ◽  
Michael Alperovich
Keyword(s):  
Cleft Lip ◽  
Tube Placement ◽  
National Database ◽  
Fisher Exact Test ◽  
Improvement Program ◽  
Surgical Quality ◽  
Exact Test ◽  
Chi Squared ◽  
Cleft Rhinoplasty ◽  
Tip Rhinoplasty

Objective: To assess the timing, type, and associated adjunct procedures for secondary cleft rhinoplasty nationally. Design: Data were extracted from a national database of all secondary cleft rhinoplasty procedures (Current Procedural Terminology [CPT] codes 30460 and 30462). Frequency statistics were utilized to analyze demographics, comorbidities, surgical procedures, and timing. Chi-squared analysis and Fisher exact test were used for analysis. Setting: National Surgical Quality Improvement Program-Pediatric Database. Participants: A total of 1720 patients met inclusion criteria for secondary cleft rhinoplasty repair. Interventions: No relevant intervention. Main Outcomes and Measures: Age, demographics, comorbidities, and associated procedures. Results: Over 5 consecutive years, 1720 patients underwent secondary cleft lip rhinoplasty nationally. Mean patient age was 9.3 ± 5.3 years. Unilateral cleft rhinoplasty patients were older (9.0 years) than bilateral patients (7.8 years; P = .001). Rib grafting was performed in 6.3% of patients at a mean age of 10.6 years with a higher proportion of Asian and female patients. Auricular grafts were more commonly performed by otolaryngology than plastic surgery. The most common adjunct procedures included secondary cleft lip revision (33.1%) and tympanostomy tube placement (10.2%). When subdividing by type of cleft rhinoplasty, tip rhinoplasty was performed at a mean age of 7.3 years compared to rhinoplasty with osteotomies and a major septal component at 12.1 years ( P < .001). Conclusions: This study reveals that a large proportion of cleft rhinoplasties are performed in skeletally immature patients. Although patients undergoing rib grafting, nasal osteotomies, and a major septal component were older, these procedures are still performed in a large proportion of patients who are younger than expected.

scholarly journals Impact of Obesity on Surgical Outcomes Following Laminectomy for Spinal Metastases

2018 ◽  
Vol 9 (3) ◽  
pp. 254-259 ◽  
Author(s):  
Zoe B. Cheung ◽  
Khushdeep S. Vig ◽  
Samuel J. W. White ◽  
Mauricio C. Lima ◽  
Awais K. Hussain ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Spinal Metastases ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Improvement Program ◽  
Clinical Registry ◽  
Perioperative Morbidity ◽  
Preoperative Risk Factors ◽  
Nonobese Group

Study Design: Retrospective cohort study. Objectives: To determine the effect of obesity (body mass index >30 kg/m2) on perioperative morbidity and mortality after surgical decompression of spinal metastases. Methods: The American College of Surgeons National Surgical Quality Improvement Program database is a large multicenter clinical registry that collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent decompression with laminectomy for treatment of metastatic spinal lesions between 2010 and 2014. Patients were separated into 2 cohorts based on the presence of absence of obesity. Univariate analysis and multivariate logistic regression analysis were used to analyze the effect of obesity on perioperative morbidity and mortality. Results: There was a significantly higher rate of venous thromboembolism (VTE; obese 6.6% vs nonobese 4.2%; P = .01) and pulmonary complications (obese 2.6% vs nonobese 2.2%; P = .046) in the obese group compared with the nonobese group. The nonobese group had prolonged hospitalization (obese 62.0% vs nonobese 69.0%; P = .001) and a higher incidence of blood transfusions (obese 26.8% vs nonobese 34.2%; P < .001). On multivariate analysis, obesity was found to be an independent risk factor for VTE (odds ratio = 1.75, confidence interval = 1.17-2.63, P = .007). Conclusions: Obese patients were predisposed to an elevated risk of VTE following laminectomy for spinal metastases. Early postoperative mobilization and a low threshold to evaluate for perioperative VTE are important in these patients in order to appropriately diagnose and treat these complications and minimize morbidity.

General Complications after Endoscopic Sinus Surgery in Smokers: A 2005-2016 NSQIP Analysis

2020 ◽  
pp. 000348942095248
Author(s):  
Jordan I. Teitelbaum ◽  
Catie Grasse ◽  
Dennis Quan ◽  
Ralph Abi Hachem ◽  
Bradley J. Goldstein ◽  
...  
Keyword(s):  
Cigarette Smoke ◽  
Endoscopic Sinus Surgery ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Sinus Surgery ◽  
National Database ◽  
Complication Rates ◽  
Improvement Program ◽  
Level Of Evidence ◽  
American College Of Surgeons

Background: Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events. Results: 921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI ( P = .0067) and pulmonary embolism ( P = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, P = .0347) of organ/space SSI after ESS. Conclusions: This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them. Level of Evidence: 2c (“health outcomes”)

Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis

2020 ◽  
pp. 000313482097157
Author(s):  
Simon Peter T. Tiu ◽  
Luv N. Hajirawala ◽  
Claudia Leonardi ◽  
Kurt G. Davis ◽  
Guy R. Orangio ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Quality Improvement ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Short Term ◽  
Improvement Program ◽  
Delayed Surgery ◽  
Acs Nsqip ◽  
Urgent Surgery ◽  
Significant Difference

Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. Objective The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. Design The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Setting The ACS NSQIP database from 2013 to 2016 was evaluated. Patients Adult patients undergoing nonelective, nonemergency colectomy for UC. Main Outcome Measures 30-day morbidity and mortality. Results 921 patients underwent urgent inpatient surgery for UC. In univariate analysis, there was no significant difference between prompt and delayed surgery for wound infection, sepsis, return to operating room, or readmission. Limitations Retrospective study of a quality improvement database. Patients who underwent successful MRT did not receive surgery, so are not included in the database. Conclusions Delaying surgery to further attempt MRT does not alter short-term outcomes and may allow conversion to elective future surgery. Contrarily, medical optimization does not improve short-term outcomes.

scholarly journals Isolated severe blunt traumatic brain injury: effect of obesity on outcomes

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer T. Cone ◽  
Elizabeth R. Benjamin ◽  
Daniel B. Alfson ◽  
Demetrios Demetriades
Keyword(s):  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Treatment Center ◽  
Major Surgery ◽  
Thromboembolic Complications ◽  
Improvement Program ◽  
Obesity Class ◽  
Increased Risk ◽  
Class 1 ◽  
Underweight Patients

OBJECTIVEObesity has been widely reported to confer significant morbidity and mortality in both medical and surgical patients. However, contemporary data indicate that obesity may confer protection after both critical illness and certain types of major surgery. The authors hypothesized that this “obesity paradox” may apply to patients with isolated severe blunt traumatic brain injuries (TBIs).METHODSThe Trauma Quality Improvement Program (TQIP) database was queried for patients with isolated severe blunt TBI (head Abbreviated Injury Scale [AIS] score 3–5, all other body areas AIS < 3). Patient data were divided based on WHO classification levels for BMI: underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class 1 (30.0–34.9 kg/m2), obesity class 2 (35.0–39.9 kg/m2), and obesity class 3 (≥ 40.0 kg/m2). The role of BMI in patient outcomes was assessed using regression models.RESULTSIn total, 103,280 patients were identified with isolated severe blunt TBI. Data were excluded for patients aged < 20 or > 89 years or with BMI < 10 or > 55 kg/m2 and for patients who were transferred from another treatment center or who showed no signs of life upon presentation, leaving data from 38,446 patients for analysis. Obesity was not found to confer a survival advantage on univariate analysis. On multivariate analysis, underweight patients as well as obesity class 1 and 3 patients had a higher rate of mortality (OR 1.86, 95% CI 1.48–2.34; OR 1.18, 95% CI 1.01–1.37; and OR 1.41, 95% CI 1.03–1.93, respectively). Increased obesity class was associated with an increased risk of respiratory complications (obesity class 1: OR 1.19, 95% CI 1.03–1.37; obesity class 2: OR 1.30, 95% CI 1.05–1.62; obesity class 3: OR 1.55, 95% CI 1.18–2.05) and thromboembolic complications (overweight: OR 1.43, 95% CI 1.16–1.76; obesity class 1: OR 1.45, 95% CI 1.11–1.88; obesity class 2: OR 1.55, 95% CI 1.05–2.29) despite a decreased risk of overall complications (obesity class 2: OR 0.82, 95% CI 0.73–0.92; obesity class 3: OR 0.83, 95% CI 0.72–0.97). Underweight patients had a significantly increased risk of overall complications (OR 1.39, 95% CI 1.24–1.57).CONCLUSIONSAlthough there was an obesity-associated decrease in overall complications, the study data did not demonstrate a paradoxical protective effect of obesity on mortality after isolated severe blunt TBI. Obese patients with isolated severe blunt TBI are at increased risk of respiratory and venous thromboembolic complications. However, underweight patients appear to be at highest risk after severe blunt TBI, with significantly increased risks of morbidity and mortality.

scholarly journals Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge

2017 ◽  
Vol 26 (3) ◽  
pp. 353-362 ◽  
Author(s):  
Meghan E. Murphy ◽  
Hannah Gilder ◽  
Patrick R. Maloney ◽  
Brandon A. McCutcheon ◽  
Lorenzo Rinaldo ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
The Elderly ◽  
National Database ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Data Set ◽  
Logistic Regression Models ◽  
Lumbar Decompression

OBJECTIVE With improving medical therapies for chronic conditions, elderly patients increasingly present as candidates for operative intervention for degenerative diseases of the spine. To date, there is a paucity of studies examining complications in lumbar decompression, without fusion, that include patients older than 80 years. Using a multicenter national database, the authors of this study evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes. METHODS The 2011–2013 American College of Surgeons' National Surgical Quality Improvement Program data set was queried for patients 65 years and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion. Morbidity and mortality within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission within 30 days or discharge to a nonhome facility. Outcomes and operative characteristics were compared using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression models. RESULTS A total of 8744 patients were identified; of these patients 4573 (52.30%) were 65 years and older. Elderly patients were stratified into 3 age categories: 85 years or older (n = 314), 75–84 years (n = 1663), and 65–74 years (n = 2596). Univariate analysis showed that, compared with age younger than 65 years, increased age was associated with the number of levels (≥ 3), readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion (all p < 0.001). On multivariable analysis and with younger than 65 years as the reference, increased age was associated with any minor complication (p < 0.001; ≥ 85 years: OR 3.47, 95% CI 1.69–7.13; 75–84 years: OR 2.34, 95% CI 1.45–3.78; and 65–74 years: OR 1.44, 95% CI 0.94–2.20), as well as discharge location other than home (p < 0.001; ≥ 85 years: OR 13.59, 95% CI 9.47–19.49; 75–84 years: OR 5.64, 95% CI 4.33–7.34; and 65–74 years: OR 2.61, 95% CI 2.05–3.32). CONCLUSIONS The authors' high-powered, multicenter analysis of lumbar decompression without fusion in the elderly, specifically including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.

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