Factors Impacting Mortality in Geriatric Patients with Acute Spine Fractures: A 12-Year Study of 613 Patients in Singapore

Abstract

Study Design Retrospective database analysis. Purpose To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore. Overview of Literature Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population. Methods Electronic records of 3,010 patients who presented to our hospital’s emergency department and who were subsequently admitted during 2004–2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80–101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality. Results Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men ( p <0.001); mortality rates increased by 6.3% ( p =0.024) for every 1-year increase in the patient’s age; and patients with an American Spinal Injury Association (ASIA) score of A–C had a much higher mortality rate compared to those with an ASIA score of D–E ( p <0.001). Conclusions An older age at presentation, male sex, and an ASIA score of A–C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.

A National Database Retrospective Review of Short-Term Postoperative Mortality in the Geriatric Population: A Comparison Between Emergency Spine Fractures and Hip Fractures

“…Gutiérrez-González et al reported that age, male sex, oncological history, and comorbidity were independent risk factors for post-spinal fracture mortality [ 16 ]. Soon et al found that mobility status and the presence of old compression fractures were also factors that influence spinal fracture mortality [ 4 ]. Our study was the first to compare risk factors of mortality in spine fractures compared to hip fractures.…”

Awake Percutaneous Fixation for Unstable Fractures of the Spine in High-risk Patients: A Retrospective Study

“…Mortality is increased markedly in older male patients or in cases in which the fracture is associated with neurologic deficit, the most common cause of death being pneumonia, followed by ischemic heart disease and cancer. 15,16…”

“…Mortality is increased markedly in older male patients or in cases in which the fracture is associated with neurologic deficit, the most common cause of death being pneumonia, followed by ischemic heart disease and cancer. 15,16 The first step in the management of these patients is recognition and diagnosis of an unstable vertebral fracture. Spinal instability is defined in the literature as a worsening deformity or displacement of the spine that compromises neurologic status of the patient and changes with time or as the inability of the spine under physiologic loads to maintain relationship between vertebrae.…”

Comparison of early results of Vesselplasty and percutaneous vertebroplasty in the treatment of elderly patients with osteoporotic vertebral compression fracture

“…Such fractures have become a common cause and cause of death in elderly fracture patients [5][6][7][8].…”