Clinical commentaryScoliosis surgery in the elderly: Complications, readmissions, reoperations and mortality

- Corrective surgery for adult idiopathic and degenerative scoliosis is increasingly being performed in the elderly.
- To our knowledge, this is the first study to stratify elderly patients into two subgroups (66-74 years and over 75 years).
- Also the first, to identify differences in surgical outcomes and discharge dispositions between the two subgroups.
- Readmission rates were lower in patients between 66-74 years, and these patients were mostly discharged home.
- Patients over the age of 75 years were more likely to be discharged to a skilled nursing facility.

The operative management of scoliosis in the elderly remains controversial. The authors of this study sought to evaluate outcomes in elderly patients with scoliosis undergoing deformity correction. Patient data was obtained from a 5% sample of the Medicare Provided Analysis and Review database (MEDPAR). Patients over 65 years of age with scoliosis undergoing corrective surgery were identified between the years 2005 to 2011. A total of 453 patients were analyzed: 262 (57%) between ages 66 to 74 years, and 191 (42%) over the age of 75 years. Female predominance (78%) was observed in this sample. Pre-diagnosis follow-up averaged 118 months. Post-surgery follow-up averaged 33 months. Patients between 66 and 74 years old were mostly discharged home, while patients over the age of 75 years were discharged to skilled nursing facilities (SNFs) (38.55% versus 34.04%, p value = 0.0011). Readmission rates were lower in patients between 66 and 74 years old when compared to patients over the age of 75 years (9.92% versus 17.28%, p value = 0.0217). Complication rates 30-days after discharge were less in patients between 66 and 74 years, compared to those over 75 years (21% versus 26.6%, respectively), but this was not statistically significant. These findings suggest varying outcomes following scoliosis surgery in the elderly, but interpretation of these results is weakened by the inherent limitations of database utilization. Future prospective studies are needed to understand risk factors and other confounding variables, such as discharge disposition, that may influence outcomes.