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Comprehensive geriatric assessment to predict adverse events in elderly patients undergoing posterior lumbar fusion surgery

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Abstract

Purpose

Although comprehensive geriatric assessment (CGA) has been used widely, its impact on adverse events in elderly patients has not been fully examined. The present study aimed to investigate the relationships between subcomponents of CGA and adverse events (AEs) in elderly patients undergoing posterior lumbar fusion surgery.

Methods

A total of 242 eligible elderly patients enrolled. Our CGA included activities of daily living, instrumental activities of daily living, nutritional status, cardiac function, pulmonary function, renal function, frailty, cognition, anxiety, depression, delirium, chronic pain score, comorbidity and polypharmacy. Comprehensive complication index was used to summarize postoperative complications and its severity. Logistic regression was performed to determine the relationships between subcomponents of a CGA and postoperative AEs.

Results

Present study found that female were more vulnerable to have AEs. Postoperative major AEs were associated with delirium (odds ratio (OR): 4.302, 95% confidence interval (CI) 1.720–10.761, p = 0.002), nutritional status (OR: 3.030, 95%CI 1.218–7.541, p = 0.017), cognitive impairment (OR: 4.122, 95%CI 1.179–14.407, p = 0.027), Charlson comorbidity index (CCI) (OR: 4.800, 95%CI 1.852–12.440, p = 0.001) and severe dependent (OR: 3.772, 95%CI 1.116–9.841, p = 0.007). Further analysis showed that delirium (OR: 2.824, 95%CI 1.068–7.467, p = 0.036) and CCI (OR: 3.221, 95%CI 1.184–8.766, p = 0.022) were independently related to major AEs.

Conclusions

These results indicate that preoperative screening preoperative delirium, cognitive, nutrition and CCI are essential to prevent postoperative major AEs of the surgical elderly.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CGA:

Comprehensive geriatric assessment

AEs:

Adverse events

ADL:

Activity of daily living

IADL:

Instrumental activity of daily living

CCI:

Charlson comorbidity index

LOS:

Length of stay

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Acknowledgements

We thank the Department of Orthopedics, Xuanwu Hospital Capital Medical University staff and all the patients who participated in the study.

Funding

This work was supported by the Beijing Hospitals Authority’s Ascent Plan [No. DFL20190802] and Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support [No. XMLX202116]. The funders played no role in the design of this study, the collection, analysis and interpretation of data or preparation of the manuscript.

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Author notes

  1. Peng Cui, Ting Liu and Zheng Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China

    Peng Cui, Ting Liu, Zheng Wang, Shuaikang Wang, Peng Wang, Chao Kong & Shibao Lu

  2. National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China

    Peng Cui, Ting Liu, Zheng Wang, Shuaikang Wang, Peng Wang, Chao Kong & Shibao Lu

Authors
  1. Peng Cui
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  2. Ting Liu
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  3. Zheng Wang
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  4. Shuaikang Wang
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  5. Peng Wang
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  6. Chao Kong
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  7. Shibao Lu
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Corresponding authors

Correspondence to Chao Kong or Shibao Lu.

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The authors declare that they have no competing interests.

Ethical statement

The study protocol was validated by the institutional review board in Xuanwu Hospital Capital Medical University (2018086). A written informed consent was obtained from all the participants in this study.

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Cui, P., Liu, T., Wang, Z. et al. Comprehensive geriatric assessment to predict adverse events in elderly patients undergoing posterior lumbar fusion surgery. Eur Spine J 33, 274–281 (2024). https://doi.org/10.1007/s00586-023-07945-5

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  • DOI: https://doi.org/10.1007/s00586-023-07945-5

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