Management of Elderly Patients with Spinal Disease: Interventional Nonsurgical Treatment

Cognitive status has been reported to affect the peri-operative and post-operative outcomes of certain surgical procedures. This prospective study investigated the effect of preoperative cognitive impairment on the postoperative course of elderly patients (n = 122, >65 years), following spine surgery for degenerative spinal disease. Data on demographic characteristics, medical history, and blood analysis results were collected. Preoperative cognition was assessed using the mini-mental state examination, and patients were divided into three groups: normal cognition, mild cognitive impairment, and moderate-to-severe cognitive impairment. Discharge destinations (p = 0.014) and postoperative cardiopulmonary complications (p = 0.037) significantly differed based on the cognitive status. Operation time (p = 0.049), white blood cell count (p = 0.022), platelet count (p = 0.013), the mini-mental state examination score (p = 0.033), and the Beck Depression Inventory score (p = 0.041) were significantly associated with the length of hospital stay. Our investigation demonstrated that improved understanding of preoperative cognitive status may be helpful in surgical decision-making and postoperative care of elderly patients with degenerative spinal disease.

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Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up

PLoS ONE ◽

10.1371/journal.pone.0260460 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260460

Author(s):

Chi Heon Kim ◽

Chun Kee Chung ◽

Yunhee Choi ◽

Juhee Lee ◽

Seung Heon Yang ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Medical Costs ◽

Nonsurgical Treatment ◽

Matched Cohort ◽

Spinal Disease ◽

Matched Cohort Study ◽

Direct Medical Costs ◽

Lumbar Spinal

Objective The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. Methods The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. Results The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. Conclusion Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.

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Outcomes of an accelerated nonsurgical management protocol for hip fractures in the elderly

Journal of Orthopaedic Surgery ◽

10.1177/2309499018803408 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901880340 ◽

Cited By ~ 4

Author(s):

Wei Xiang Lim ◽

Ernest Beng Kee Kwek

Keyword(s):

Length Of Stay ◽

Elderly Patients ◽

Hip Fractures ◽

The Elderly ◽

Operative Management ◽

Nonsurgical Treatment ◽

P Value ◽

Complication Rates ◽

Nonsurgical Management ◽

Management Protocol

The majority of hip fractures in elderly patients are managed surgically with superior outcomes. However, for patients who refuse surgery or are deemed medically unfit, traction used to be the mainstay of nonsurgical treatment, which is associated with prolonged hospitalization and inpatient complications from immobility. This study, therefore, aims to evaluate the outcomes of an early wheelchair mobilization protocol as an alternative nonsurgical treatment option. This is a retrospective study of 87 elderly patients who were managed nonsurgically for their hip fractures over a 1-year period. The accelerated rehabilitation protocol did not have them on traction but were instead mobilized with assistance as soon as possible after admission. Variables collected electronically include patient demographics, fracture characteristics, inpatient mobilization milestones, inpatient complications, Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI) scores, and radiological findings. Patients who were younger, could sit up earlier and had a shorter length of stay, were able to ambulate better at 6 months ( p value < 0.05). Patients with femoral neck fractures and shorter length of stay had better MFAC scores. A total of 58% of patients with radiological follow-up had displacement of their fractures with age, type of fracture, and length of stay as predictors ( p value < 0.05) The Charlson’s score, day to sitting up, and day to transfer affect fracture healing ( p value < 0.05). The mean length of stay was 17 days and the 1-year mortality was 18%. Surgical therapy remains the preferred choice of management for patients with hip fractures. Early wheelchair mobilization leads to a shorter length of stay compared to traditional traction methods and comparable 1-year mortality rates with operative management. Despite this, complication rates remain high and only 48% of patients achieved ambulation by 1 year, with healing in only 24% of fractures.

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Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: a nationwide matched cohort study with a 10-year follow-up

10.21203/rs.3.rs-110675/v1 ◽

2020 ◽

Author(s):

Chi Heon Kim ◽

Chun Kee Chung ◽

Yunhee Choi ◽

Juhee Lee ◽

Seung Heon Yang ◽

...

Keyword(s):

Cohort Study ◽

Indirect Costs ◽

Nonsurgical Treatment ◽

Matched Cohort ◽

Spinal Disease ◽

Matched Cohort Study ◽

Asian Medicine ◽

Lumbar Spinal

Abstract Demand for degenerative lumbar spinal disease treatments has been increasing, leading to the increased utilization of medical resources. The present study compared the direct costs between surgical and nonsurgical treatment. The national health insurance service sample cohort was used in a matched cohort study comparing surgical treatment (n=2,698) with nonsurgical treatment (n=2,698). Insurance covers both Western and Asian medicine. First, the overall monthly costs were compared between cohorts. Second, the monthly costs were compared at 1, 3, 6, 9, and 12 months after treatment and yearly thereafter for 10 years. The surgery cohort spent $50.84/patient/month, and the nonsurgery cohort spent $29.34/patient/month (p<0.01). Surgery cost more ($2,762) than nonsurgical interventions ($180.4) (p<0.01). Compared with the nonsurgery cohort, the surgery cohort paid $33/month more for the first 3 months, paid less for the first 12 months, and paid approximately the same over the course of 10 years. Surgery initially cost more than nonsurgical interventions, but the costs incurred during the follow-up period were not higher. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, quality of life and societal willingness to pay.

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Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

BioMed Research International ◽

10.1155/2014/231948 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 33

Author(s):

Yohan Robinson ◽

Anna-Lena Robinson ◽

Claes Olerud

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Elderly Patients ◽

Complication Rate ◽

Treatment Guidelines ◽

The Elderly ◽

Nonsurgical Treatment ◽

Bony Union ◽

Type Ii ◽

Odontoid Fractures

Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.

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