P15. Impact of age on the occurrence of vascular complications in patients undergoing anterior lumbar approach surgery

Background Context

With increased longevity, the number of patients with symptomatic, degenerative spinal conditions is increasing. Anterior approach lumbar spinal surgery may facilitate use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of anterior approach lumbar spinal surgery, risks related to vascular injury in older patients have been described in the literature.

Purpose

The purpose of this study was to investigate the impact of age on the incidence of vascular complications in a large series of patients undergoing anterior lumbar approach surgery.

Study Design/Setting

This was a retrospective cohort study.

Patient Sample

The study was based on 751 consecutive patients who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation, total disc replacement (TDR), or hybrid surgery (ALIF and TDR) for the treatment of degenerative spinal pathology. Patients with surgeries greater than 3 levels, or who underwent surgery for fracture, tumor, complex deformity, or involving a lateral approach were excluded.

Outcome Measures

The primary outcome measures were the incidence of intraoperative vascular injuries and postoperative vascular complications (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)).

Methods

Charts were reviewed to collect general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications. Rates of vascular complications were compared across age groups divided by decade of age. Data were also analyzed comparing the mean age of patients with no vascular complications to those in each of the vascular complication subgroups.

Results

The overall mean age was 50.4 years (range 20-83 years). The majority of patients (53.1%) underwent combined ALIF/posterior surgery, 31.7% underwent TDR, 11.3% underwent ALIF, and the remaining patients underwent hybrid surgery. With respect to the number of levels operated: 468 were 1-level, 253 were 2-level, and 30 were 3-level. Mean estimated blood loss was 91.3 mL (range 10-2800 ml). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins. The mean blood loss in these cases was 721 ml and all were successfully repaired intraoperatively. Postoperatively, 6 patients, 0.8%, developed DVT and/or PE (one patient had both intra and postoperative vascular complications). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates (all p>.38). Additionally, there were no statistically significant differences in the mean ages of patients with vs those without vascular complications (all p>.17). Further analyses confirmed that the lack of relationship between age and vascular events could not be attributed to the possible confounding factors of the number of levels operated or anterior only vs anterior/posterior surgery.

Conclusions

The overall incidence of vascular complications was 2.0%. No relationship between vascular complications and patient age was found. While there is generally increased concern for vascular complications in older patients undergoing anterior approach lumbar spine surgery, these data suggest that increased age is not necessarily a contraindication for this approach.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.