Impact of Age, Injury Severity Score, and Medical Comorbidities on Early Complications After Fusion and Halo-Vest Immobilization for C2 Fractures in Older Adults A Propensity Score Matched Retrospective Cohort Study
Propensity score matched retrospective cohort study.
To report early complication rates and associated risk factors in patients with C2 fractures who underwent fusion or halo immobilization.
There is limited data on the impact of age, injury severity score, and medical comorbidities on overall complication rates from surgical fixation versus halo-vest immobilization of C2 fractures.
The Nationwide Inpatient Sample database from 2002 to 2008 was queried to identify cohorts of adult patients (age ≥ 18 years) with C2 fractures without spinal cord injury who were treated with either fusion or halo-vest immobilization. Complication rates, hospital length of stay, and costs were compared in a propensity score matched sample. Multivariate analysis was used to identify predictors of in-hospital complications.
A total of 3758 patients (1627 fusion and 2131 halo) were identified. Fusion was associated with greater overall complication rates (20.2% vs. 10.1%, P < 0.0001), increased length of stay (8.9 d vs. 6.4 d, P < 0.0001), higher charges ($80,000 vs. $41,000, P < 0.0001), but a lower rate of nonroutine discharge (52.6% vs. 62.6%, P < 0.0001). There was no difference in mortality between the fusion group (2.75%) and the halo group (3.33%). Age, injury score, and comorbidity increased complication rates by a similar degree (odds ratio) in both cohorts. Patients aged 80 years and older were 3.5 times more likely to have a complication than those younger than 60 years.
Fusion patients had greater overall complication rates, increased length of stay, and greater resource utilization but were discharged home in a greater proportion. Both fusion and halo were associated with significant (more than 3-fold) increase in complication rates in elderly patients aged 80 years or older. Given the similar mortality rate between the fusion group and the halo group and the higher cost and complication rate in the fusion group, our study supports the use of halo-vest immobilization in patients where operative therapy is contraindicated.
"This review also could not identify the risk factors of mortality. Boakye claims that mortality is independent of the type of treatment and that age is the main risk factor . For others age, a neurological deficit and concomitant injuries may be risk factors of mortality and the type of treatment alone was not the only cause of death. "
[Show abstract][Hide abstract] ABSTRACT: The frequency of cervical spine trauma in elderly patients is increasing with most injuries occurring in the upper cervical spine. These fractures are associated with a risk of sometimes life-threatening complications, although very few studies have specifically analyzed this. The goal of this study was to identify the incidence of complications in the literature (mortality and morbidity) following upper cervical spine trauma in elderly patients.
A systematic search was performed on the MEDLINE database without limiting the search by language or date to identify all studies reporting the rate of complications after upper cervical spine trauma in patients over the age of 60.
Twenty-four observational studies were included, four were comparative. These studies included a total of 857 patients, mean age 76. Nearly all traumas were odontoid process fractures, and most were treated surgically (57%). The median mortality rate was 9.2% (Q1-Q3: 2.5-19.6) and the median rate of short-term complications was 15.4% (Q1-Q3: 5.8-26.9). The main late stage complication was nonunion, which developed in a mean 10 to 12% depending on the type of treatment.
Complications following cervical spine trauma are frequent in elderly patients whatever the type of treatment. Knowledge of the rate of complications in the literature and the potential risk factors is essential for the clinician to improve the information provided to patients and to prevent complications.
Systematic review of the literature. Level of evidence IV.
Orthopaedics & Traumatology Surgery & Research 08/2013; 43(6). DOI:10.1016/j.otsr.2013.07.007 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In small series, endoscopic third ventriculostomy (ETV) has been shown to potentially have similar efficacy as ventriculoperitoneal shunting (VPS) for idiopathic normal pressure hydrocephalus (iNPH). Therefore, some clinicians have advocated for ETV to avoid the potential long-term complications associated with VPS. Complication rates for these procedures vary widely based on limited, small series data.
We utilized a nationwide database that provides a comprehensive investigation of peri-operative safety of ETV for iNPH as compared to VPS.
We identified discharges with the primary diagnosis of idiopathic Normal Pressure Hydrocephalus (iNPH) (International Classification of Diseases (ICD-9) code 331.5) with ICD-9 primary procedure codes for ventriculoperitoneal shunt (02.34) and endoscopic third ventriculostomy (02.2) from 2007-2010. We analyzed short-term safety outcomes using univariate and hierarchical logistic regression analyses.
There were a total of 652 discharges for ETV for iNPH and 12,845 discharges for VPS for iNPH over the study period. ETV was associated with a significantly higher mortality (3.2% vs 0.5%) and short-term complication rate (17.9% vs. 11.8%) than VPS despite similar mean modified comorbidity scores. In multivariate analysis, ETV alone predicted increased mortality and increased length of stay when adjusted for other patient and hospital factors.
This is the first study that robustly assesses the peri-operative complications and safety outcomes of ETV for iNPH. Compared to VPS, ETV is associated with greater peri-operative mortality and complication rates. This consideration is important to weigh against the potential benefit of ETV: avoiding long-term shunt dependence. Prospective, randomized studies are needed.
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