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Clinical Orthopaedics and Related Research®

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01-12-2014 | Clinical Research

What Is the Effect of Advanced Age and Comorbidity on Postoperative Morbidity and Mortality After Musculoskeletal Tumor Surgery?

Authors: Koichi Ogura, MD, Hideo Yasunaga, MD, PhD, Hiromasa Horiguchi, PhD, Kiyohide Fushimi, MD, PhD, Hirotaka Kawano, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2014

Abstract

Background

Although the elderly population is increasing rapidly, little information is available regarding how the risk of postoperative mortality and morbidity increases when combined with age and comorbidity burden in patients undergoing musculoskeletal tumor surgery.

Questions/purposes

We evaluated the effect of age and comorbidity burden on the (1) postoperative complication rate and (2) in-hospital mortality rate after musculoskeletal tumor surgery.

Methods

We identified 5716 patients undergoing musculoskeletal tumor surgery during 2007 to 2012 using a Japanese national inpatient database. Logistic regression analyses were performed to examine the relationships of various factors with the rates of mortality and morbidity.

Results

The postoperative complication rate (6.7%) was associated with male sex (p = 0.033), age 80 years or older (p = 0.001), tumor located in the lower extremity (p = 0.001) or trunk (p = 0.019), Charlson Comorbidity Index of 4 or greater (p < 0.001), blood transfusion (p < 0.001), and duration of anesthesia of 240 minutes or longer (p < 0.001). The in-hospital mortality (0.8%) was related to the Charlson Comorbidity Index of 4 or greater (p < 0.001), blood transfusion (p < 0.001), and high hospital volume (p = 0.016). The morbidity (21.6%; OR, 3.29; p < 0.001) and mortality (4.1%; OR, 5.95; p < 0.001) in patients 80 years or older with a Charlson Comorbidity Index of 4 or greater was increased three and six times, respectively, compared with patients 64 years or younger with no comorbidity.

Conclusions

We found that age and comorbidity burden together greatly increased the risk of morbidity and mortality. Our study showed quantitative evidence that will assist physicians in assessing perioperative risk accurately and provide a more informative explanation to elderly patients undergoing musculoskeletal tumor surgery.

Level of Evidence

Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Title: What Is the Effect of Advanced Age and Comorbidity on Postoperative Morbidity and Mortality After Musculoskeletal Tumor Surgery?
Authors: Koichi Ogura, MD
Hideo Yasunaga, MD, PhD
Hiromasa Horiguchi, PhD
Kiyohide Fushimi, MD, PhD
Hirotaka Kawano, MD, PhD
Publication date: 01-12-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3889-y

At a glance: The STEP trials

Springer Medicine

What Is the Effect of Advanced Age and Comorbidity on Postoperative Morbidity and Mortality After Musculoskeletal Tumor Surgery?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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