Safety of Combined Anterior and Posterior Fusion in the Elderly Population

Multisurgeon, single-institution retrospective observational cohort. Compare complications and outcomes between patients less than 70 years (<70Y) and 70 years or older (&#x2265;70Y) undergoing antero-posterior lumbar fusion. The safety of antero-posterior lumbar fusion surgery in elderly patients remains debated, with concerns about increased perioperative risk and poorer outcomes. Patients undergoing short-segment antero-posterior lumbar fusion for degenerative indications were identified. Standard demographics, surgical data, complications (in-hospital, 30-, 90-, and 365&#xa0;d postoperative), and revisions after the index procedure were collected and compared between propensity-matched patients &#x2265;70Y and <70Y. After propensity score matching, 83 patients were included in each cohort for a total of 166 patients with similar sex distribution, body mass index, ASA ( P =0.347), smoking status, proportion of revision surgeries, and number of levels fused. Surgical time and estimated blood loss were similar between the two cohorts. Nonhome discharge was significantly more frequent in the older cohort (33% vs. 10%, P =0.001). There was no difference in overall complication rates or at any individual interval: in-hospital, 30-day, 90-day, and 1-year. In a propensity-matched cohort undergoing anterior-posterior lumbar fusion, elderly patients had similar intraoperative, 30-day, 90-day, and 1-year complications and length of hospitalization, suggesting baseline co-morbidity burden rather than age alone may account for much of the observed excess risk. Age alone should not preclude consideration of circumferential fusion when clinically indicated.