Predictors of 30-Day Outcomes in Octogenarians with Traumatic C2 Fractures Undergoing Surgery

Yue, John K.; Ordaz, Angel; Winkler, Ethan A.; Deng, Hansen; Suen, Catherine G; Burke, John F.; Chan, Andrew K.; Manley, Geoffrey T.; Dhall, Sanjay S.; Tarapore, Phiroz E.

doi:10.1016/j.wneu.2018.05.237

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Higher ASA class and transfer from another facility likely indicate patients with more health complexity, potentially consistent with neurological deficits and presence of other injuries. Another study by Yue et al 22 showed that bleeding disorder/ coagulopathy and intensive care unit (ICU) admission following traumatic C2 fracture surgery were associated with increased odds of complication. Again, these are similar to our findings, which show that at least one preoperative comorbidity, overall worse health status, as measured by ASA class, and transfer from another facility are associated with increased odds of at least one complication.…”

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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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mentioning

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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Surgical management of spinal pathologies in the octogenarian: a narrative review

Evans,

Bakhsheshian,

Graffeo

et al. 2024

GeroScience

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Inpatient outcome of upper cervical fractures in the elderly: a retrospective analysis of 268 cases.

Hoeh,

Keuchel,

Pieroh

et al. 2023

Preprint

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Background The incidence of upper cervical fractures in elderly individuals is increasing, necessitating enhanced treatment approaches. Method A retrospective study of 268 elderly patients with upper cervical fractures was conducted to assess inpatient outcomes aged 75 and older with atlas and/or axis fractures. Patient risk was evaluated using the ASA score and Charlson comorbidity index (CCI). In-hospital mortality and functional outcomes were assessed, with fracture treatment strategies following AO principles. Results Patients with C1, C2 or combined fractures did not differ in age, CCI, Barthel score or length of hospital stay (p > 0.05). C2 fractures were predominant, and the majority of patients suffered at least from a severe general disease (ASA ≥ 3). Comparing operatively and conservatively treated patients, regardless of fracture localization, revealed no significant differences in mortality, both overall and time-related. Surgical patients experienced a higher frequency of general complications, notably dyspnea. The overall mortality rate was 14.9%, with 15.7% in the nonoperative group and 14.4% in the surgical group (p = 0.8628). The overall rate of general complications was 51.4% (n = 51) in the nonoperative group and 71.9% (n = 110) in the operatively treated group. Conclusion The in-hospital mortality and morbidity of elderly patients with upper cervical fractures are high but do not significantly differ between operatively and nonoperatively treated patients. The complexity of the geriatric patient population highlights the need for peri- and postinpatient geriatric complex treatment, emphasizing the importance of establishing geriatric-specialized care structures.

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Predictors of 30-Day Outcomes in Octogenarians with Traumatic C2 Fractures Undergoing Surgery

Cited by 4 publications

References 32 publications

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

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

Surgical management of spinal pathologies in the octogenarian: a narrative review

Inpatient outcome of upper cervical fractures in the elderly: a retrospective analysis of 268 cases.

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