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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Elderly 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.</jats:p></jats:sec>

In-Hospital Mortality for the Elderly with Acute Traumatic Spinal Cord Injury

“…This is consistent with the findings by Martin and coworkers, 20 who described an ''inflection point'' at the age of 75 for in-hospital mortality following cervical SCI. Our overall in-hospital mortality rate of 16% is slightly lower than the 12-40% reported by others, [15][16][17][18][19][20] but our data may underestimate the rate, as some patients who died shortly after admission may not have been enrolled in the registry.…”

“…In-hospital mortality rates in elderly patients with tSCI are reported as being 12–40%, 15–20 considerably higher than the estimated mortality of <5% in younger patient populations. 16 Previously identified risk factors for mortality in the elderly include older age, higher cervical level of injury, neurological severity, and increasing number of comorbidities; 17 , 18 , 20 however, to our knowledge, no one has developed a clinical decision-making aid using a combination of these factors for in-hospital mortality for this elderly population.…”

“… 27 Few studies focus on in-hospital mortality of the elderly population, with fewer comparing this outcome following surgical and non-surgical interventions. 17 , 19 Further, most studies compare the elderly with a younger population 13 , 15 , 16 , 20 or involve only cervical SCI or spine fractures. 15 , 17 , 19 , 20 , 28–30 Further understanding on the clinical course of elderly patients with tSCI and the specific risk factors for those who die despite aggressive surgical management will inform early communication and shared decision making between clinicians and patients and family.…”

Discharge prediction of critical patients with spinal cord injury: a machine learning study with 1485 cases

“…The copyright holder for this preprint this version posted June 30, 2021. ; https://doi.org/10.1101/2021.06.26.21259569 doi: medRxiv preprint other study [4]. Anyway, the imbalanced three-class categories did not significantly compromise the prediction accuracy in the current study.…”

“…More importantly, critical SCI patients may suffer from a higher mortality due to renal failure, respiratory failure, hemodynamic instability, sepsis from urinary tract infection, life-threatening autonomic hyper-reflexia etc. [3][4][5][6][7][8] . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”