• Varun Puvanesarajah, Jourdan M Cancienne, Brian C Werner, Amit Jain, Anuj Singla, Adam L Shimer, Francis H Shen, and Hamid Hassanzadeh.
• Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
• Spine. 2018 Jan 1; 43 (1): 16-21.

Study DesignA retrospective database review.ObjectiveThe aim of this study was to compare the occurrence of complications in patients treated with one to two-level, three to seven-level, and more than eight level fusions.Summary Of Background DataElderly patients constitute a rapidly growing demographic with an increasing need for spinal procedures. Complication rates for spinal surgery in elderly patients range from 37% to 80% with major complications occurring in 12% to 21% of patients.MethodsThe PearlDiver database (2005-2012) was utilized to compare perioperative complication rates in patients aged 65 years and older undergoing posterolateral fusion of one to two (n = 90,527); three to seven (n = 23,827), and more than eight (n = 2758) thoracolumbar levels. Cohorts were matched by demographics and comorbidities. Ninety-day medical and surgical complication and mortality rates were determined.ResultsIn the full, unmatched cohort, the major complication rate was 15.9%, with matched cohorts of one to two, three to seven, and eight-level fusions associated with major complication rates of 12.5%, 20.5%, and 35.4%, respectively. Patients treated with 8+ level fusions had 3.8 and 2.1 times greater odds of developing a major complication than patients treated with 1 to 2 and 3 to 7-level fusions, respectively (P < 0.0001). Patients treated with more than eight-level fusions had 3.9 and 10.8 times increased odds of experiencing mortality than those treated with three to seven-level and one to two-level fusions, respectively.ConclusionElderly patients treated with spine fusions spanning more than eight levels experience significantly increased complication rates when compared with patients treated with fusions of shorter length.Level Of Evidence3.

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