Perioperative Clinical Observation Of Lumbar Degenerative Disease In Geriatric Patients

Objective: To analyze the perioperative medical records of geriatric patients with lumbar degenerative diseases and explore their perioperative characteristics.Methods: Medical records of patients admitted to our hospital for lumbar decompression and fusion surgery due to degenerative disease of the lumbar spine from January 2015 to October 2018 were collected.After screening by inclusion criteria and exclusion criteria,medical records of 230 geriatric patients(Y?75 years old)were finally included in this study.Medical records of 378 elderly patients(65?Y < 75 years old)receiving posterior lumbar decompression and fusion surgery due to degenerative lumbar diseases in our hospital at the same time period were collected.The perioperative medical records analyzed included:(1)general information: age,gender,co-morbidity,osteoporosis,and anesthesia risk score(American Society of Anesthesiologists,ASA);(2)surgery material: patients preoperative hospitalization time,operation time,intraoperative blood loss,hospital stay,postoperative complications,general complications related to the operation,the application of Selective nerve root block(SNRB),consultation,between flow rate and postoperative wound drainage tube indwelling time,catheter indwelling time.(3)changes in clinical efficacy: Visual analoge score(VAS)and Oswestry disability index(ODI)before surgery,3 months after surgery,6 months after surgery,12 months after surgery,and at the last follow-up.SPSS20.0 was used for statistical analysis.P < 0.05 was considered statistically significant.Results: All patients successfully completed the operation and were discharged from the hospital without any adverse events such as positioning error or death.There were 133 cases of single-segment fusion,308 cases of double-segment fusion,and 167 cases of fusion of three or more segments.There were 378 patients in the elderly group,175 male patients and 203 female patients,average age of 67.3±3.1 years,followed up for 12 to 51 months(25.2±6.6 months).230 patients in the geriatric group,96 male patients and 134 female patients,average age of 77.3±2.2 years,followed up for 12 to 51 months(23.4±8.0 months).At the last follow-up,VAS score and ODI score of patients in the two groups were significantly improved compared with those before surgery(P < 0.05),but there was no significant difference between the two groups(P > 0.05).In terms of the general information of patients in the two groups,the average age,the average ASA score and the average number of co-morbidity of patients in the geriatric group were significantly higher than those in the elderly group(P < 0.05).There was no significant difference in gender ratio and follow-up time between the two groups(P >.05).In terms of surgical data,the postoperative hospital stay and catheter indwelling time of the geriatric group were significantly higher than that of the elderly group(P < 0.05).The proportion of perioperative consultation times and preoperative necessary SNRB in the geriatric group was higher than that in the elderly group,with significant difference(P < 0.05).There was no significant difference between the two groups in preoperative hospital stay,operation time,wound drainage tube indwelling time,intraoperative blood loss and postoperative wound drainage(P > 0.05).In terms of the incidence of surgical-related complications,there was no significant difference between the elderly group(12.7%)and the geriatric group(13.0%)(P > 0.05).The incidence of general complications was 10.3% and 15.7%,respectively,with significant differences(P < 0.05).At the last follow-up,VAS scores of the two groups were significantly improved compared with those before the operation,with significant difference(P < 0.05),but no significant difference between the two groups.During the preoperative follow-up,the ODI scores of patients in both groups were significantly improved compared with those before the operation,with significant difference(P < 0.05),but no significant difference between the groups.Conclusion:Analysis of perioperative case data of geriatric patients showed that they had more co-morbidity and higher anesthesia ASA score.The perioperative process of the geriatric patients is more complicated,the perioperative hospitalization time,the number of consultation in the department,the application of necessary nerve root block,the postoperative catheter indwelling time are longer,and the perioperative complication rate of the geriatric patients is higher.After systematic perioperative evaluation,VASA score and ODI score were significantly improved in geriatric patients,geriatric patients can safely pass the perioperative period and obtain satisfactory results.