Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

Ahn, Henry; Bailey, Chris; Rivers, Carly S.; Noonan, Vanessa K.; Tsai, Eve C.; Fourney, Daryl R.; Attabib, Najmedden; Kwon, Brian K.; Christie, Sean; Fehlings, Michael G.; Finkelstein, Joel; Hurlbert, R. John; Townson, Andrea; Parent, Stefan; Drew, Brian; Chen, Jason; Dvorak, Marcel F.

doi:10.1503/cmaj.150085

Cited by 56 publications

(42 citation statements)

References 17 publications

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“…Ahn et al performed a multicenter study of 1440 operative and nonoperative patients to determine the impact of older age on treatment decisions and outcomes. 2 In a multivariate analysis, these authors found that patients aged 65 years and older have lower odds of undergoing surgery (OR 0.39) and a longer time to surgery (37 hours vs 19 hours in younger patients).…”

Section: Discussionmentioning

confidence: 97%

“…There are too few contemporary studies examining perioperative in-hospital morbidity and mortality in elderly patients with SCI who have undergone surgical management. 2 Given current trends in surgical practice and modern medicine, we hypothesize that elderly patients have improved outcomes compared to those in previous studies and that elderly and younger patients may even attain similar outcomes. In this study, we closely examine the perioperative outcomes of SCI patients aged 70 years or older and compare them to outcomes in a younger cohort and in the literature.…”

mentioning

confidence: 89%

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Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Lau

Ore

Tarapore

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 89%

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Lau

Ore

Tarapore

et al. 2019

Neurosurgical Focus

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“…Although typically occurring most frequently in younger males from motor vehicle or sports injury, in tSCI there is an epidemiological shift in the population relating to aging ''baby boomers'' that has increased the average age at injury. 16,17 By 2032, the greatest proportion of new tSCI is predicted to be in patients over 70 years of age, with an estimated 46% of the newly injured being over the age of 60 years. 18 Injuries in the elderly are most often incurred by falls from a standing height, which may be exacerbated by age-related degenerative disc disease.…”

Section: Introductionmentioning

confidence: 99%

“…23,24 The clinical management of older individuals with new tSCI provides a challenge for clinicians, evidenced by a previous study in which older patients were operated on less frequently, and at a longer interval from admission. 16 Whereas clinical decision-making involves a subjective assessment of risk of poor outcomes with consideration of the overall accumulation of deficit, assessment of frailty would assist in clinical decision-making and risk management.…”

Section: Introductionmentioning

confidence: 99%

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

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Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

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“…7 This shift in the demographics of SCI and TBI is important because the acute care and rehabilitation of older patients with SCI or TBI present unique challenges, the health-care resources consumed are greater, and the outcomes are poorer than those in young patients. 8,9 For example, older patients often have substantial comorbidities, and hence might be less able than younger patients to tolerate the extensive surgeries that can be indicated for severe SCI or TBI. 10 The GBD 2016 TBI and SCI Collaborators' study was made possible by the resources and wealth of information contained within the GBD 2016 frame work, and makes use of all accessible data, including in patient and outpatient health records, literature studies, and survey data.…”

Section: Global Burden Of Traumatic Brain and Spinal Cord Injurymentioning

confidence: 99%