Predictors of 30-Day Outcomes in Octogenarians with Traumatic C2 Fractures Undergoing Surgery

• Published in: World neurosurgery Vol. 116; pp. e1214 - e1222
• Main Authors: Yue, John K., Ordaz, Angel, Winkler, Ethan A., Deng, Hansen, Suen, Catherine G., Burke, John F., Chan, Andrew K., Manley, Geoffrey T., Dhall, Sanjay S., Tarapore, Phiroz E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: Axis fracture; C2 fracture; Cervical spine surgery; Elderly; Inpatient complications; Octogenarian; Outcomes; CHF; NTDB; Octogenarian; DVT; OR; CI; ISS; HLOS; NSP; SNF; Cervical spine surgery; UTI; Outcomes; QoL; Axis fracture; ICU; MI; C2 fracture; Elderly; ARDS; Inpatient complications; ED
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.237

Predictors of surgical outcomes following traumatic axis (C2) fractures in octogenarians remain undercharacterized. Patients age ≥80 years undergoing cervical spine surgery following traumatic C2 fractures were extracted from the National Sample Program of the National Trauma Data Bank (2003-2012). Outcomes include overall inpatient complications, individual complications with an incidence >1%, hospital length of stay (HLOS), discharge disposition, and mortality. Demographics, comorbidities, and injury predictors were analyzed using multivariable regression. Odds ratios (OR), mean differences, and 95% confidence intervals (CIs) were calculated. Statistical significance was assessed at P < 0.05. The cohort of 442 patients was 48.6% male and had a mean age of 84.3 ± 2.7 years. The distribution of admissions was 42.3% to the hospital floor, 40.3% to the intensive care unit (ICU), 7.7% to telemetry, 2.0% to the operating room, and 7.7% to other/unknown. Mortality was 9.7%, mean HLOS was 13.1 ± 9.2 days, the rate of complications was 38.5%, and 81.5% of survivors were discharged to a nonhome facility. Injury severity was predictive of mortality and overall complications. History of bleeding disorder/coagulopathy predicted mortality (OR, 4.02; 95% CI, 1.07–15.05), overall complications (OR, 3.01; 95% CI, 1.09–8.32), cardiac arrest (OR, 8.19; 95% CI, 1.06–63.54), and renal complications (OR, 10.36; 95% CI, 2.13–50.38). History of congestive heart failure predicted mortality (OR, 3.10; 95% CI, 1.10–8.69). ICU admission (vs. floor) predicted overall complications (OR, 2.01; 95% CI, 1.23–3.27) and pneumonia (OR, 4.65; 95% CI, 1.91–11.30). Telemetry admission (vs. floor) predicted unplanned intubation (OR, 7.76; 95% CI, 1.24–48.49). In this cohort of octogenarians undergoing surgery for traumatic C2 fracture, injury severity and a history of bleeding disorder/coagulopathy were identified as risk factors for inpatient complications and mortality. Heightened surveillance should be considered for ICU and/or telemetry admissions for the development of complications. These findings warrant consideration by the clinician, patient, and family to inform clinical decisions and goals of care. •In 442 octogenarians undergoing surgery for traumatic C2 fracture, mortality was 9.7%.•Hospital length of stay was 13.1 ± 9.2 days, 38.5% had complications, and 81.5% were discharged to a nonhome facility.•Bleeding disorder/coagulopathy (BD/C) predicted mortality (odds ratio [OR], 4.02).•BD/C predicted any complications (OR, 3.01), cardiac arrest (OR, 8.19), and renal complications (OR, 10.36).•CHF predicted mortality (OR, 3.10), and ICU admission predicted any complications and pneumonia.