Our next speaker is Dr. DiGiorgio. Elderly patients have worse EQ5D outcomes after spondylolisthesis surgery compared with young patients, yet they are satisfied. Hello, my name is Anthony DiGiorgio, PGY6 here at LSU in New Orleans. Thank you to the Scientific Committee for letting me talk and thank you to Dr. Mumineti and the UCSF group for allowing me to be involved with this project. This is, this specific project is a QOD project that was largely put together by Dr. Andrew Chan at UCSF and I'm happy to be able to present on his behalf. Disclosure, the QOD project, this one specifically was partially funded by the NREF and a Medtronic grant to the NREF. I have no personal disclosures to give here. So, we've been over these randomized clinical trials before. There's two very good trials on spondylolisthesis showing that some patients do benefit from surgery or from fusions in this. However, both of these studies excluded any patients that are over 80 years of age. And this could be looked at as a problem of randomized controlled trials as they aren't always applicable to broad patient populations that we see every day in our clinic. And I know we all do see patients over the age of 80 that may present with spondylolisthesis. So, what are we gonna do with these patients? And that's really where registry data comes in and is largely beneficial because registry data really does sort of give you a overview of real world data showing multiple sites and patients that aren't excluded due to age or other exclusions. So, the Spondylolisthesis Study Group is a part of the Lumbar Spine QOD. It is the 12 highest enrolling sites. And this data was pooled to basically examine the patients over the age of 80 compared to those that were under the age of 80. So, the elderly to the young patients looked at standardized patient reported outcomes, the NASS satisfaction score and then readmission and re-operation rates. And you can see the 12 sites here. Demographics, I apologize, it's a little small, but of course the patient groups differed on age. The elderly patients had slightly lower BMIs. They had less depression, excuse me, less anxiety, greater incidence of osteoporosis. And at baseline, they had slightly better back pain and slightly better EQ5D scores than the young patients. The dominant symptoms were similar. The elderly patients, fewer of them were independently ambulatory preoperatively and far fewer of them actually underwent a fusion procedure than the young patients, which tends to make sense and I think reflects real world practices. In terms of the outcomes, the EBL and operative time were lower. This makes sense if fewer patients are undergoing fusions. The length of hospitalization was actually lower in the elderly patients, probably also again related to the fact that fewer of them are having fusions. But more patients in the young group were actually discharged to home. Fewer patients in the elderly group. The three month and 12 month re-operation and re-admission rates were similar across groups. The patient reported outcomes. The back pain, the difference in back pain after surgery was actually greater in the younger group. So the elderly group had less of an improvement in their NRS back pain and the elderly group also had less of an improvement in the EQ5D. However, they did have statistically significant improvement over their baseline. So they did improve from surgery, they just didn't improve as well as the young patients. But despite all that, despite not improving as much, their NAS satisfaction scores were almost identical as the young patients. So about 83% in both the elderly and young patients had a NAS satisfaction score of one or two, which means that they're overall satisfied with their surgery and would do it again under the same circumstances. In a multivariate analysis, looking at baseline back pain scores and baseline EQ5D scores, it showed that being elderly actually led to significant reductions in NRS leg pain and EQ5D. So that the elderly patients, even on multivariate analysis, did not show as much of an EQ5D improvement after surgery for spondylolisthesis. So in conclusion, elderly status is independently associated with worse outcomes in EQ5D and leg pain at 12 months. However, despite this, the patients are very satisfied with their surgeries and they still do show significant improvements over their baseline scores. So I think this gives a good indication that operating on these patients and carefully selected can be a benefit to them. So I have to acknowledge these are the QOD sites and the QOD directors of these sites. Thank you very much for your time. Thank you. Thanks very much.

spondylolisthesis surgery

elderly patients

young patients

registry data

real-world outcomes