Precision risk stratification for perioperative safety of minimally invasive versus open TLIF in elderly patients with lumbar degenerative disease

Precision risk stratification for perioperative safety of minimally invasive versus open TLIF in elderly patients with lumbar degenerative disease. Download PDF Abstract Lumbar degenerative disease is highly prevalent in elderly patients, and transforaminal lumbar interbody fusion (TLIF) is a standard surgical treatment. The comparative safety of minimally invasive (MIS-TLIF) versus open TLIF in this vulnerable population remains incompletely defined, particularly regarding effect modifiers and underlying mechanisms.

This retrospective cohort study included 728 patients aged ≥ 60 years who underwent primary TLIF, with 1:1 propensity score matching (PSM) performed to balance baseline characteristics. Perioperative outcomes were compared, and 30-day complications were analyzed using the Fine-Gray competing risk model. Subgroup analysis, mediation analysis, and a gradient boosting machine learning predictive model were conducted to explore effect heterogeneity, mechanisms, and risk stratification.

After PSM, all baseline variables were well balanced (all standardized mean differences < 0.05). The MIS-TLIF group exhibited significantly shorter operative time, less intraoperative blood loss, lower transfusion rates, faster postoperative recovery, and reduced 30-day and 90-day unplanned readmission rates (all P < 0.001). After adjusting for competing risks, MIS-TLIF was associated with a 52% lower risk of any 30-day complication (adjusted subdistribution hazard ratio [SHR] = 0.48, 95% CI 0.34–0.68, P < 0.001) and a 61% lower risk of major complications (adjusted SHR = 0.39, 95% CI 0.21–0.72, P = 0.003).

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