Incidence and Causes of In-Hospital Mortality Following Elective Spine Surgery in Elderly Patients: A Retrospective Multicenter Study of a Prospective Cohort

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  • Ohira Shunsuke
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Yamato Yukimasa
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Taniguchi Yuki
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG) Surgical Center, The University of Tokyo Hospital
  • Kawamura Naohiro
    University of Tokyo Spine Group (UTSG) Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
  • Iizuka Tetsusai
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Kanto Rosai Hospital
  • Higashikawa Akiro
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Kanto Rosai Hospital
  • Komatsu Naoto
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Yokohama Rosai Hospital
  • Takeshita Yujiro
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Yokohama Rosai Hospital
  • Tozawa Keiichiro
    University of Tokyo Spine Group (UTSG) Spine Center, Toranomon Hospital
  • Fukushima Masayoshi
    University of Tokyo Spine Group (UTSG) Spine Center, Toranomon Hospital
  • Urayama Daiki
    University of Tokyo Spine Group (UTSG) Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center
  • Ono Takashi
    University of Tokyo Spine Group (UTSG) Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center
  • Hara Nobuhiro
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital
  • Masuda Kazuhiro
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center
  • Azuma Seiichi
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital
  • Iwai Hiroki
    Inanami Spine and Joint Hospital
  • Oshina Masahito
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, NTT Medical Center
  • Sugita Shurei
    University of Tokyo Spine Group (UTSG) Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
  • Hirai Shima
    University of Tokyo Spine Group (UTSG) Spine Center, National Hospital Organization Sagamihara National Hospital
  • Sasaki Katsuyuki
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Nakarai Hiroyuki
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Ohtomo Nozomu
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Nakamoto Hideki
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Kato So
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Matsubayashi Yoshitaka
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)
  • Tanaka Sakae
    Department of Orthopaedic Surgery, The University of Tokyo
  • Oshima Yasushi
    Department of Orthopaedic Surgery, The University of Tokyo University of Tokyo Spine Group (UTSG)

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<p>Introduction: Despite an increase in the demand for surgical treatment of elderly patients with degenerative spinal disorders, little is known about mortality following spinal surgery in this population. This study aims to identify the incidence and causes of in-hospital mortality in elderly patients after elective spine surgery.</p><p>Methods: We extracted the data of patients aged ≥65 years who underwent elective spine surgery between December 12, 2016, and May 31, 2022, from our prospective multicenter cohort. The primary outcome was the in-hospital mortality rate. Univariate analysis was conducted to identify potential risk factors for postoperative mortality. The detailed clinical course of patients who died was retrospectively investigated using medical records.</p><p>Results: A total of 10,976 eligible patients (5,976 males and 5,000 females), with a mean age of 75.5 years, were identified. There were eight in-hospital deaths (0.07%). Univariate analyses showed that the eight patients were significantly older (82.1 years vs. 75.5 years, P=0.008), were more frequently hemodialysis-dependent (50.0% vs. 2.9%, P<0.001), and had a higher proportion of cases with cervical surgery (62.5% vs. 17.0%, P<0.001) and preoperative American Society of Anesthesiologists Physical Status ≥3 (87.5% vs. 14.6%, P<0.001). Death occurred at a median of 24.5 days postoperatively. The causes of in-hospital death were as follows: gastrointestinal diseases in five cases (ischemic colitis in three cases, panperitonitis in one, and intestinal perforation in one), sepsis due to unknown causes in two, and lethal arrhythmia in one. The initial symptoms preceding the lethal clinical course were mainly common gastrointestinal symptoms, such as abdominal pain, anorexia, diarrhea, and vomiting.</p><p>Conclusions: The main cause of in-hospital mortality was gastrointestinal disease. Surgeons should be aware that common gastrointestinal symptoms can be the initial symptoms of a subsequent lethal clinical course in elderly patients.</p>

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