• Michael H Lawless, Doris Tong, Chad F Claus, Connor Hanson, Chenxi Li, Clifford M Houseman, Peter Bono, Boyd F Richards, Prashant S Kelkar, Muwaffak M Abdulhak, Victor Chang, Daniel A Carr, Paul Park, and Teck M Soo.
• Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI.
• Spine. 2022 Feb 15; 47 (4): 343351343-351.

Study DesignRetrospective analysis of prospectively collected registry data using multivariable analyses of imputed data.ObjectiveWe sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF).Summary Of Background DataElderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan.MethodsThe study included all patients who had 1 to 4 level ACDF (September 2015-August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used.ResultsNine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39-0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27-0.61 95% CI).ConclusionAge was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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