Outcomes and Complications of Surgery for Symptomatic Spinal Metastases; a Comparison Between Patients Aged ≥ 70 and <70

Abstract

Study Design Retrospective cohort study. Objective Physicians may be deterred from operating on elderly patients due to fears of poorer outcomes and complications. We aimed to compare the outcomes of surgical treatment of spinal metastases patients aged ≥70-yrs and <70-yrs Materials and Methods This is a retrospective study of patients surgically treated for metastatic epidural spinal cord compression and spinal instability between January-2005 to December-2021. Follow-up was till death or minimum 1-year post-surgery. Outcomes included post-operative neurological status, ambulatory status, medical and surgical complications. Two Sample t-test/Mann Whitney U test were used for numerical variables and Pearson Chi-Squared or Fishers Exact test for categorical variables. Survival was presented with a Kaplan-Meier curve. P < .05 was significant. Results We identified 412 patients of which 29 (7.1%) patients were excluded due to loss to follow-up and previous surgical treatment. 79 (20.6%) were ≥70-yrs. Age ≥70-yrs patients had poorer ECOG scores ( P = .0017) and Charlson Comorbidity Index ( P < .001). No significant difference in modified Tokuhashi score ( P = .393) was observed with significantly more ≥ prostate ( P < .001) and liver ( P = .029) cancer in ≥70-yrs. Improved or maintained normal neurological function ( P = .934), independent ambulatory status ( P = .171), and survival at 6 months ( P = .119) and 12 months ( P = .659) was not significantly different between both groups. Medical ( P = .528) or surgical ( P = .466) complication rates and readmission rates ( P = .800) were similar. Conclusion ≥70-yrs patients have comparable outcomes to <70-yr old patients with no significant increase in complication rates. Age should not be a determining factor in deciding surgical management of spinal metastases.