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Cost and Complications of Single-Level Lumbar Decompression in Those Over and Under 75: A Matched Comparison.

: Patients aged 75 and over experience similar rates of medical complications following single-level lumbar decompression, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates. Subsequent procedures did vary by age.


STUDY DESIGN
Retrospective database analysis.


OBJECTIVE
This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and over.


SUMMARY OF BACKGROUND DATA
Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined.


METHODS
The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared.


RESULTS
The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and over age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, p = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and over (9.66% vs. 9.28%, P = 0.051), although the 75 and over age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867 respectively, P = 0.013 and < 0.001 respectively). The 75 and over age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement.


CONCLUSIONS
Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates.