Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

Bank, Matthew; Gibbs, Katie; Sison, Cristina; Kutub, Nawshin; Paptheodorou, Angelos; Lee, Samuel; Stein, Adam; Bloom, Ona

doi:10.1177/2151459318770882

Cited by 27 publications

(18 citation statements)

References 32 publications

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“…Among the elderly, cervical spine fractures are common, especially compared with other age brackets. 1,2 Of all cervical spine fractures, C2 level fractures have been shown to be most common and have demonstrated an increasing incidence over recent years. 1,3,4 One recent study demonstrated a 135% increase in the rate of C2 fractures from 2000 to 2011.…”

Section: Introductionmentioning

confidence: 99%

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

Bernstein

Thirukumaran

Raudenbush³

et al. 2019

Global Spine Journal

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Study Design: Retrospective database review. Objectives: To determine factors associated with unplanned readmission, complications, and mortality in patients undergoing operative management for C2 fractures. Methods: The American College of Surgeons–National Surgical Quality Improvement Program (ACS NSQIP) was queried between 2007 and 2014. Unplanned readmission, any complication, and mortality were the outcomes of interest. Bivariate statistics were calculated, and multivariate regression models were estimated. Results: A total of 285 patients were enrolled. Readmission data was available for 199 patients and 11 patients (5.5% of 199 patients) had an unplanned readmission. Overall, 60 patients (21% of 285 patients) had at least 1 complication and 15 patients (5.3% of 285 patients) died. Five factors were associated with complications: transferred from another facility (odds ratio [OR] 3.00, 95% confidence interval [CI]1.51-5.98; P < .01); operative time ≥180 minutes (OR 2.43, 95% CI 1.11-5.36; P = .03); at least 1 patient comorbidity (OR 2.50, 95% CI 1.01-6.18; P < .05); American Society of Anesthesiologists (ASA) class 3 (OR 4.86, 95% CI 1.19-19.88; P = .03); and ASA class 4 (OR 7.24, 95% CI 1.66-31.66; P = .01). The only factor associated with unplanned readmission was having at least one postoperative complication (OR 7.10, 95% CI 1.04-48.59; P < .05), while patients who were partially or totally dependent from a functional standpoint were at increased odds of death (OR 3.98, 95% CI 1.12-14.08; P = .03). Conclusions: Patients with functional limitations have increased odds of death, while patients with postoperative complications have increased odds of unplanned readmission. Being transferred from an outside facility, having an operative time ≥180 minutes, having at least one comorbidity, and being classified as ASA class 3 or 4 increase patient odds of complication.

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Section: Introductionmentioning

confidence: 99%

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

Bernstein

Thirukumaran

Raudenbush³

et al. 2019

Global Spine Journal

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“…In their study, <50% of patients required mechanical ventilation at the time of admission and they ascribed higher extubation rate to a Glasgow Coma Scale of 15 and administration of comprehensive multidisciplinary care. In a retrospective analysis of SCI patients admitted to a state-designated Level 1 trauma center in a HIC, Mathew et al reported a hospital stay of 14.1 days and ventilator dependence of 3.5 days, with acute in-hospital mortality of <10% [ 16 ]. Most of the data regarding stay are reported from rehabilitation centers.…”

Section: Discussionmentioning

confidence: 99%

Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India

Sengupta

Bindra

Kumar

et al. 2021

Spinal Cord Ser Cases

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Study design Descriptive retrospective. Objectives To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC). Setting Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. Methods A total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records. Results A total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free. Conclusions The ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.

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“…Management of cervical spine injury in the elderly remains controversial because of many influencing factors such as the quality of the bone, osteoarthritis, classification, and type of the fracture [6,7,10,19,20]. Treatment might be complicated by numerous comorbidities and reduced bone quality.…”

Section: Discussionmentioning

confidence: 99%

“…Injuries to the upper cervical spine represent a serious entity including a wide spectrum of pathology ranging from benign to life threatening [1]. Especially in the elderly, these injuries are not uncommon and their incidence will continue to grow due to increasing life expectancy and higher activity levels of the elderly population [5][6][7][8][9]. Currently, the emphasis centers on surgical treatment to obtain good alignment and stability to allow early mobilization.…”

Section: Introductionmentioning

confidence: 99%

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

Wenning

Hoffmann

2020

J Orthop Surg Res

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Background: The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods: Over a 5-year period (2010-2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results: Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Conclusion: Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

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Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

Cited by 27 publications

References 32 publications

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

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