The AOSpine North America Geriatric Odontoid Fracture Mortality Study: A Retrospective Review of Mortality Outcomes for Operative Versus Nonoperative Treatment of 322 Patients with Long-Term Follow-Up

Details

• Personal Author:
  Arnold P ; Chapman J ; Fehlings MG ; Kopjar B ; Shaffrey CI ; Smith JS ; Vaccaro AR
• Description:
  Study Design. Retrospective, multicenter cohort study. Objective. Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. Summary of Background Data. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. Methods. This is a retrospective study of consecutive patients aged 65 years or older with type II odontoid fracture from 3 level I trauma centers from 2003-2009. Demographics, comorbidities, and treatment were abstracted from medical records. Mortality outcomes were obtained from medical records and a public database. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. Results. A total of 322 patients were included (mean age, 81.8 yr; range, 65.0-101.5 yr). Compared with patients treated nonoperatively (n = 157), patients treated operatively (n = 165) were slightly younger (80.4 vs. 83.2 yr, P = 0.0014), had a longer hospital (15.0 vs. 7.4 d, P < 0.001) and intensive care unit (1.5 vs. 1.1 d, P = 0.008) stay, and were more likely to receive a feeding tube (18% vs. 5%, P = 0.0003). Operative and nonoperative treatment groups had similar sex distribution (P = 0.94) and Charlson comorbidity index (P = 0.11). Within 30 days of presentation, 14% of patients died, and at maximal follow-up (average = 2.05 yr; range = 0 d-7.02 yr), 44% had died. On multivariate analysis, nonoperative treatment was associated with higher 30-day mortality (HR = 3.00, 95% CI = 1.51-5.94, P = 0.0017), after adjusting for age (HR = 1.10, 95% CI = 1.05-1.14; P < 0.0001), male sex (P = 0.69), and Charlson comorbidity index (P = 0.16). At maximal follow-up, there was a trend toward higher mortality associated with nonoperative treatment (HR = 1.35, 95% CI = 0.97-1.89, P = 0.079), after adjusting for age (HR = 1.07, 95% CI = 1.05-1.10; P < 0.0001), male sex (HR = 1.55, 95% CI = 1.10-2.16; P = 0.012), and Charlson comorbidity index (HR = 1.28, 95% CI = 1.16-1.40; P < 0.0001). Conclusion. Surgical treatment of type II odontoid fracture in this elderly population did not negatively impact survival, even after adjusting for age, sex, and comorbidities. The data suggest a significant 30-day survival advantage and a trend toward improved longer-term survival for operatively treated over nonoperatively treated patients. [Description provided by NIOSH]
• Subjects:
  Age Factors Cohort Studies Mortality Occupational Health Safety
• Keywords:
  Age Factors Bone Disorders Cohort Studies Health Care Mortality Rates Surgery Traumatic Injuries
• ISSN:
  0362-2436
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Kansas ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 7 ; Pennsylvania ; Virginia ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  38
• Issue:
  13
• NIOSHTIC Number:
  nn:20056176
• Citation:
  Spine 2013 Jun; 38(13):1098-1104
• Contact Point Address:
  Justin S. Smith, MD, PhD, Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville VA, 22908
• Email:
  jss7f@virginia.edu
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of Washington
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Spine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1e76929d811fb8d519ae3b8e86f4d3919539bdc691048534d5a637ce82b1d6e393b584e5ecc8da79e02c1d6ad8c25bf294c03be2a1859ea90db5d1c60fed669b
• Download URL:
  https://stacks.cdc.gov/view/cdc/213832/cdc_213832_DS1.pdf
• File Type:
  [PDF - 630.75 KB ]