Many people over 60 years old experience severe back pain and seek surgery to relieve it. But some of them may be at risk for complications.
Recent research looked at data on people who had undergone surgery for lumbar stenosis, a painful back problem, to see if complications were common among certain groups.
The researchers found that complications of surgery, some of which are fatal, increased with age and were more likely for people with heart problems, diabetes and other preexisting health issues.
The authors of this study noted that these results may change the way doctors treat and monitor lumbar stenosis patients with certain risk factors.
Richard Deyo, MD, MPH, from the Departments of Family Medicine, Medicine, Public Health and Preventive Medicine and the Center for Research on Occupational and Environmental Toxicology at Oregon Health & Science University, led this study which examined complications among patients who had undergone surgery for lumbar stenosis.
Lumbar stenosis occurs when the spine narrows and compresses inward, putting pressure on the spinal cord and nerves of the lower back. People with lumbar stenosis often experience pain in their back and legs, especially when they stand or walk.
Lumbar stenosis is more common in older people who have more "wear-and-tear" on their spine.
Many patients with lumbar stenosis seek surgery to treat the pain. Surgery for lumbar stenosis usually involves cutting and removing a part of a spinal disc or part of a vertebra called the lamina.
Complications sometimes accompany surgery for lumbar stenosis. This study aimed to see what complications occurred in people who had lumbar stenosis surgery and how common they were.
The researchers used the Veterans Health Administration's National Surgical Quality Improvement Program, or VASQIP. VASQIP is a database on postoperative complications among individuals — mostly veterans — seeking treatment at a VA Medical Center.
A total of 12,154 patients who had undergone surgery for lumbar stenosis were selected for this study. Most of them were men in their 60s. Patients who had other significant medical problems, like spinal infections, cancer, and fractures, were excluded.
The researchers looked at people who experienced complications including infection, heart attack, pneumonia, coma and stroke.
They found that major complications occurred in 2.1 percent of patients who sought lumbar stenosis surgery. A total of 3.2 percent of cases resulted in wound complications like infections. Only 0.6 percent of patients died within 90 days after surgery.
The most common complications were pneumonia, sepsis (severe infection) and respiratory or cardiac failure resulting in reintubation.
People who were younger than 50 were less likely to experience major medical complications and death than older people. Four percent of patients older than 80 years experienced complications. However, wound infections did not increase or decrease substantially across different ages.
People with chronic shortness of breath, heart disease or a history of steroid use were more likely to experience surgical complications. People with diabetes were similarly at a greater risk of having complications, but the risk decreased among patients who controlled the disease with diet rather than insulin.
This study was published in Spine in September.
The research was funded by the National Institute for Arthritis, Musculoskeletal and Skin Diseases, a National Center for Research Resources grant and a grant from the Research Enhancement Award Program of the VA. The authors disclosed board membership and payment for manuscript preparation as financial activities outside the submitted work.