Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges

Asemota, Anthony O.; Ahmed, A. Karim; Purvis, Taylor E.; Passias, Peter G.; Goodwin, C. Rory; Sciubba, Daniel M.

doi:10.1016/j.wneu.2018.07.228

Cited by 30 publications

(35 citation statements)

References 34 publications

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“…The observation of more patients admitted with hip fractures (92.5%) than those with cervical fracture (7.5%) over the same period of study are almost the same as figures (93.8% versus 6.2%) reported from a large study of US patients [14]. The proportions of women and men (72.2% versus 27.8%) admitted with hip fractures were similar to figures reported from studies of high income countries [4] and the slightly greater number of men than women (54.9% versus 45.1%) with cervical fractures is also similar to those reported from other studies [9,12,14,21]. Most of the cervical fractures were due to falls, which are again consistent with previous reports [9].…”

Section: Discussionsupporting

confidence: 88%

“…The proportions of women and men (72.2% versus 27.8%) admitted with hip fractures were similar to figures reported from studies of high income countries [4] and the slightly greater number of men than women (54.9% versus 45.1%) with cervical fractures is also similar to those reported from other studies [9,12,14,21]. Most of the cervical fractures were due to falls, which are again consistent with previous reports [9]. On the other hand, the aetiologies of cervical fractures in younger adults (< 60 years) are very different, mostly arising from contact and collision sports such as rugby [22], football, gymnastics [23] and diving [24], as well as road traffic accidents [8].…”

Section: Discussionsupporting

confidence: 88%

“…By contrast, cervical spine fractures occur far less frequently than hip fractures [7], but the incidence also increases with age [8] and has been rising in recent years. A study of 167,278 older US adults admitted with cervical fractures showed a big increase in the rates of hospitalisation (from 26/100,000 to 68/100,000) and mortality (from 3/100,000 to 6/100,000) between 2001 and 2010 [9]. Mortality among hospital patients with cervical fractures has been reported to be 8-14% [9,10], and 28-37% within 1 year of the fracture [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

et al. 2020

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Patients admitted with a cervical fracture are twice as likely to die within 30 days of injury than those with a hip fracture. However, guidelines for the management of cervical fractures are less available than for hip fractures. We hypothesise that outcomes may differ between these types of fractures. We analysed 1359 patients (406 men, 953 women) with mean age of 83.8 years (standard deviation = 8.7) admitted to a National Health Service hospital in 2013–2019 with a cervical (7.5%) or hip fracture (92.5%) of similar age. The association of cervical fracture (hip fracture as reference), hospital length of stay (LOS), co-morbidities, age and sex with outcomes (acute delirium, new pressure ulcer, and discharge to residential/nursing care) was assessed by stepwise multivariate logistic regression. Acute delirium without history of dementia was increased with cervical fractures: odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.3–4.7, age ≥ 80 years: OR = 3.5 (95% CI = 1.9–6.4), history of stroke: OR = 1.8 (95% CI = 1.0–3.1) and ischaemic heart disease: OR = 1.9 (95% CI = 1.1–3.6); pressure ulcers was increased with cervical fractures: OR = 10.9 (95% CI = 5.3–22.7), LOS of 2–3 weeks: OR = 3.0 (95% CI = 1.2–7.5) and LOS of ≥ 3 weeks: OR = 4.9, 95% CI = 2.2–11.0; and discharge to residential/nursing care was increased with cervical fractures: OR = 3.2 (95% CI = 1.4–7.0), LOS of ≥ 3 weeks: OR = 4.4 (95% CI = 2.5–7.6), dementia: OR = 2.7 (95% CI = 1.6–4.7), Parkinson’s disease: OR = 3.4 (95% CI = 1.3–8.8), and age ≥ 80 years: OR = 2.7 (95% CI = 1.3–5.6). In conclusion, compared with hip fracture, cervical fracture is more likely to associate with acute delirium and pressure ulcers, and for discharge to residency of high level of care, independent of established risk factors.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

et al. 2020

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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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“…The nationwide databases showed that the incidence of cervical fractures with or without spinal cord injury among the elderly population beyond 65 years is increasing over the past decade. Most patients included in this population group have multiple comorbidities such as cancer, heart failure, cerebrovascular disease, and diabetes, and are receiving treatments for these conditions before sustaining an injury [26, 27]. Adjusted-population rates of in-hospital mortality after spinal injury also revealed increasing trends in the elderly [28].…”

Section: Discussionmentioning

confidence: 99%

Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury

et al. 2019

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Introduction Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. Methods A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. Results All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. Conclusions The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.

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Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges

Cited by 30 publications

References 34 publications

Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

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

Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury

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