Degenerative Scoliosis Correction Is Safe in Elderly Patients with Coronary Artery Disease

TL;DR

Scoliosis surgery in elderly patients with heart disease is generally safe, with only slightly higher heart-related risks.

Contribution

This study shows that CAD patients can safely undergo scoliosis surgery with proper risk management.

Findings

CAD patients had higher cardiac complications but no increased mortality.

Non-CAD patients had higher rates of returning to surgery and antibiotic issues.

Proper preoperative screening may mitigate risks for CAD patients.

Abstract

Background/Objectives: Coronary Artery Disease (CAD) is one of the leading causes of death in the United States. Although there is a plethora of studies about CAD, there remains a gap in the literature in examining the role of CAD in patients who undergo spine surgery. In this study, we examine the role of CAD in postoperative outcomes in adult patients who underwent surgery for degenerative scoliosis. Methods: The Scoliosis Research Society Database was queried for patients with degenerative scoliosis and divided into two cohorts: CAD and non-CAD. To minimize confounding bias, propensity score matching was done on comorbidities and patient demographics. Outcomes examined included: intraoperative complications, postoperative outcomes, and mortality rate. After matching, there were 139 patients in each group. Results: The CAD group had significantly higher rates of cardiac-related complications (5.8% vs. 0%, p = 0.012). No other intraoperative complications had significant differences between the groups. Interestingly, the non-CAD group had both a higher rate of returning to surgery (46.8% vs. 33.8%, p = 0.038) and antibiotic-related complications (5.8% vs. 0.7%, p = 0.042) respectively. There were no other differences regarding postoperative outcomes, including mortality. Conclusions: Our study found that aside from cardiac-related complications, the CAD group did not have any worse outcomes, and in some cases did better. These results are promising and may be due to more extensive preoperative screening and more risk aversion in patients with CAD. Our findings suggest that if spine surgeons exercise risk management for cardiac complications, CAD patients may benefit greatly from scoliosis surgery at no increased risk.

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