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  • Morbidity and Mortality Associated With Operative Management of Traumatic C2 Fractures in Octogenarians

    Final Number:

    Ethan A. Winkler MD PhD; John K. Yue BA; John Frederick Burke MD, PhD; Praveen V. Mummaneni MD; Geoffrey T. Manley MD, PhD; Phiroz E. Tarapore MD; Sanjay S. Dhall MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The management of axis fractures and particularly of odontoid fractures in the elderly remains controversial. As a greater segment of the U.S. population lives past 80, it is becoming increasingly evident that published morbidity and mortality profiles of C2 fractures in younger cohorts (55+) are not applicable to octogenarians. Consequently, there is a need for further study in this specific population.

    Methods: Using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), we performed a retrospective analysis of patients with age = 80 years and traumatic C2 fracture. Demographics, inpatient complications and the outcome endpoints of mortality, hospital length of stay (LOS), and discharge disposition were described between non-operative and operative cohorts. Multi-variable regression analyses were performed.

    Results: From 2003-2012, 3,847 people met inclusion criteria, which represents 17,702 incidents nationally. The overall incidence of operative management was 10.3%. Operative management was associated with increased risk of pneumonia (10.1% vs. 5.9%, p<0.001), acute respiratory distress syndrome (6.0% vs. 2.3%, p<0.001), and decubitus ulcer (4.8% vs. 1.3%, p<0.001). Inpatient mortality was 12.8% for all subjects and was not significantly different between non-operative and operative cohorts (non-operative 13%; operative 10.3%; p=0.120). Overall hospital LOS was 8.31 ± 9.32 days (non-operative 7.78 ± 9.21; operative 12.86 ± 9.07; p<0.001) and showed an adjusted mean increase of 5.68 days with operative management (95% CI [4.74-6.61]). Of patients who survived to discharge, 26% returned home (non-operative 26.8%; operative: 18.8%; p=0.001). Patients who underwent operative management were less likely to return home (OR 0.59, 95% CI [0.44-0.78]).

    Conclusions: The present study confirms that operative management of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases the rate of discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer higher rates of medical complications during their stay.

    Patient Care: It will provide evidence-based description of peri-operative risk for the surgical intervention in patients aged 80 years or older with traumatic C2 fratures.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the morbidity associated with operative management of C2 fractures in those aged 80 or older; 2) Identify common inpatient complications and points of emphasis of post-operative care in octogenarians with cervical fixation; 3) To describe in better detail the risks and benefits of cervical fixation in octogenarians with traumatic C2 fractures


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