Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature

Japan Association of Spine Surgeons with Ambition Multicenter Study

Kazuyoshi Kobayashi, Shiro Imagama, Kei Ando, Naoki Ishiguro, Masaomi Yamashita, Yawara Eguchi, Morio Matsumoto, Ken Ishii, Tomohiro Hikata, Shoji Seki, Hidetomi Terai, Akinobu Suzuki, Koji Tamai, Masaaki Aramomi, Tetsuhiro Ishikawa, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito & 40 others Kei Yamada, Michio Hongo, Yuji Matsuoka, Hidekazu Suzuki, Atsushi Nakano, Kazuyuki Watanabe, Hirotaka Chikuda, Junichi Ohya, Yasuchika Aoki, Masayuki Shimizu, Toshimasa Futatsugi, Keijiro Mukaiyama, Masaichi Hasegawa, Katsuhito Kiyasu, Haku Iizuka, Yoichi Iizuka, Ryoichi Kobayashi, Kotaro Nishida, Kenichiro Kakutani, Hideaki Nakajima, Hideki Murakami, Satoru Demura, Satoshi Kato, Katsuhito Yoshioka, Takashi Namikawa, Kei Watanabe, Kazuyoshi Nakanishi, Yukihiro Nakagawa, Mitsunori Yoshimoto, Hiroyasu Fujiwara, Norihiro Nishida, Yasuaki Imajo, Masashi Yamazaki, Masataka Sakane, Tetsuya Abe, Kengo Fujii, Takashi Kaito, Takeo Furuya, Sumihisa Orita, Seiji Ohtori

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P <.05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P <.05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P <.05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

Original languageEnglish
Pages (from-to)560-566
Number of pages7
JournalGlobal Spine Journal
Volume7
Issue number6
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Delirium
Multicenter Studies
Japan
Spine
Cerebrovascular Disorders
Retrospective Studies
Odds Ratio
Hypertension
Surgeons
Thorax
Logistic Models
Databases
Morbidity
Mortality
Incidence

Keywords

  • complication
  • delirium
  • extremely elderly
  • risk factors
  • spine surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature : Japan Association of Spine Surgeons with Ambition Multicenter Study. / Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Ishiguro, Naoki; Yamashita, Masaomi; Eguchi, Yawara; Matsumoto, Morio; Ishii, Ken; Hikata, Tomohiro; Seki, Shoji; Terai, Hidetomi; Suzuki, Akinobu; Tamai, Koji; Aramomi, Masaaki; Ishikawa, Tetsuhiro; Kimura, Atsushi; Inoue, Hirokazu; Inoue, Gen; Miyagi, Masayuki; Saito, Wataru; Yamada, Kei; Hongo, Michio; Matsuoka, Yuji; Suzuki, Hidekazu; Nakano, Atsushi; Watanabe, Kazuyuki; Chikuda, Hirotaka; Ohya, Junichi; Aoki, Yasuchika; Shimizu, Masayuki; Futatsugi, Toshimasa; Mukaiyama, Keijiro; Hasegawa, Masaichi; Kiyasu, Katsuhito; Iizuka, Haku; Iizuka, Yoichi; Kobayashi, Ryoichi; Nishida, Kotaro; Kakutani, Kenichiro; Nakajima, Hideaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Namikawa, Takashi; Watanabe, Kei; Nakanishi, Kazuyoshi; Nakagawa, Yukihiro; Yoshimoto, Mitsunori; Fujiwara, Hiroyasu; Nishida, Norihiro; Imajo, Yasuaki; Yamazaki, Masashi; Sakane, Masataka; Abe, Tetsuya; Fujii, Kengo; Kaito, Takashi; Furuya, Takeo; Orita, Sumihisa; Ohtori, Seiji.

In: Global Spine Journal, Vol. 7, No. 6, 01.09.2017, p. 560-566.

Research output: Contribution to journalArticle

Kobayashi, K, Imagama, S, Ando, K, Ishiguro, N, Yamashita, M, Eguchi, Y, Matsumoto, M, Ishii, K, Hikata, T, Seki, S, Terai, H, Suzuki, A, Tamai, K, Aramomi, M, Ishikawa, T, Kimura, A, Inoue, H, Inoue, G, Miyagi, M, Saito, W, Yamada, K, Hongo, M, Matsuoka, Y, Suzuki, H, Nakano, A, Watanabe, K, Chikuda, H, Ohya, J, Aoki, Y, Shimizu, M, Futatsugi, T, Mukaiyama, K, Hasegawa, M, Kiyasu, K, Iizuka, H, Iizuka, Y, Kobayashi, R, Nishida, K, Kakutani, K, Nakajima, H, Murakami, H, Demura, S, Kato, S, Yoshioka, K, Namikawa, T, Watanabe, K, Nakanishi, K, Nakagawa, Y, Yoshimoto, M, Fujiwara, H, Nishida, N, Imajo, Y, Yamazaki, M, Sakane, M, Abe, T, Fujii, K, Kaito, T, Furuya, T, Orita, S & Ohtori, S 2017, 'Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study', Global Spine Journal, vol. 7, no. 6, pp. 560-566. https://doi.org/10.1177/2192568217700115
Kobayashi, Kazuyoshi ; Imagama, Shiro ; Ando, Kei ; Ishiguro, Naoki ; Yamashita, Masaomi ; Eguchi, Yawara ; Matsumoto, Morio ; Ishii, Ken ; Hikata, Tomohiro ; Seki, Shoji ; Terai, Hidetomi ; Suzuki, Akinobu ; Tamai, Koji ; Aramomi, Masaaki ; Ishikawa, Tetsuhiro ; Kimura, Atsushi ; Inoue, Hirokazu ; Inoue, Gen ; Miyagi, Masayuki ; Saito, Wataru ; Yamada, Kei ; Hongo, Michio ; Matsuoka, Yuji ; Suzuki, Hidekazu ; Nakano, Atsushi ; Watanabe, Kazuyuki ; Chikuda, Hirotaka ; Ohya, Junichi ; Aoki, Yasuchika ; Shimizu, Masayuki ; Futatsugi, Toshimasa ; Mukaiyama, Keijiro ; Hasegawa, Masaichi ; Kiyasu, Katsuhito ; Iizuka, Haku ; Iizuka, Yoichi ; Kobayashi, Ryoichi ; Nishida, Kotaro ; Kakutani, Kenichiro ; Nakajima, Hideaki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Namikawa, Takashi ; Watanabe, Kei ; Nakanishi, Kazuyoshi ; Nakagawa, Yukihiro ; Yoshimoto, Mitsunori ; Fujiwara, Hiroyasu ; Nishida, Norihiro ; Imajo, Yasuaki ; Yamazaki, Masashi ; Sakane, Masataka ; Abe, Tetsuya ; Fujii, Kengo ; Kaito, Takashi ; Furuya, Takeo ; Orita, Sumihisa ; Ohtori, Seiji. / Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature : Japan Association of Spine Surgeons with Ambition Multicenter Study. In: Global Spine Journal. 2017 ; Vol. 7, No. 6. pp. 560-566.
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T1 - Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature

T2 - Japan Association of Spine Surgeons with Ambition Multicenter Study

AU - Kobayashi, Kazuyoshi

AU - Imagama, Shiro

AU - Ando, Kei

AU - Ishiguro, Naoki

AU - Yamashita, Masaomi

AU - Eguchi, Yawara

AU - Matsumoto, Morio

AU - Ishii, Ken

AU - Hikata, Tomohiro

AU - Seki, Shoji

AU - Terai, Hidetomi

AU - Suzuki, Akinobu

AU - Tamai, Koji

AU - Aramomi, Masaaki

AU - Ishikawa, Tetsuhiro

AU - Kimura, Atsushi

AU - Inoue, Hirokazu

AU - Inoue, Gen

AU - Miyagi, Masayuki

AU - Saito, Wataru

AU - Yamada, Kei

AU - Hongo, Michio

AU - Matsuoka, Yuji

AU - Suzuki, Hidekazu

AU - Nakano, Atsushi

AU - Watanabe, Kazuyuki

AU - Chikuda, Hirotaka

AU - Ohya, Junichi

AU - Aoki, Yasuchika

AU - Shimizu, Masayuki

AU - Futatsugi, Toshimasa

AU - Mukaiyama, Keijiro

AU - Hasegawa, Masaichi

AU - Kiyasu, Katsuhito

AU - Iizuka, Haku

AU - Iizuka, Yoichi

AU - Kobayashi, Ryoichi

AU - Nishida, Kotaro

AU - Kakutani, Kenichiro

AU - Nakajima, Hideaki

AU - Murakami, Hideki

AU - Demura, Satoru

AU - Kato, Satoshi

AU - Yoshioka, Katsuhito

AU - Namikawa, Takashi

AU - Watanabe, Kei

AU - Nakanishi, Kazuyoshi

AU - Nakagawa, Yukihiro

AU - Yoshimoto, Mitsunori

AU - Fujiwara, Hiroyasu

AU - Nishida, Norihiro

AU - Imajo, Yasuaki

AU - Yamazaki, Masashi

AU - Sakane, Masataka

AU - Abe, Tetsuya

AU - Fujii, Kengo

AU - Kaito, Takashi

AU - Furuya, Takeo

AU - Orita, Sumihisa

AU - Ohtori, Seiji

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P <.05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P <.05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P <.05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

AB - Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P <.05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P <.05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P <.05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

KW - complication

KW - delirium

KW - extremely elderly

KW - risk factors

KW - spine surgery

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