Retrospective, multicenter cohort study.
Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures.
There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures.
This is a retrospective study of consecutive patients aged 65 years or older with type II odontoid fracture from 3 level I trauma centers from 2003–2009. Demographics, comorbidities, and treatment were abstracted from medical records. Mortality outcomes were obtained from medical records and a public database. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated.
A total of 322 patients were included (mean age, 81.8 yr; range, 65.0–101.5 yr). Compared with patients treated nonoperatively (n = 157), patients treated operatively (n = 165) were slightly younger (80.4 vs. 83.2 yr, P = 0.0014), had a longer hospital (15.0 vs. 7.4 d, P < 0.001) and intensive care unit (1.5 vs. 1.1 d, P = 0.008) stay, and were more likely to receive a feeding tube (18% vs. 5%, P = 0.0003). Operative and nonoperative treatment groups had similar sex distribution (P = 0.94) and Charlson comorbidity index (P = 0.11). Within 30 days of presentation, 14% of patients died, and at maximal follow-up (average = 2.05 yr; range = 0 d–7.02 yr), 44% had died. On multivariate analysis, nonoperative treatment was associated with higher 30-day mortality (HR = 3.00, 95% CI = 1.51–5.94, P = 0.0017), after adjusting for age (HR = 1.10, 95% CI = 1.05–1.14; P < 0.0001), male sex (P = 0.69), and Charlson comorbidity index (P = 0.16). At maximal follow-up, there was a trend toward higher mortality associated with nonoperative treatment (HR = 1.35, 95% CI = 0.97–1.89, P = 0.079), after adjusting for age (HR = 1.07, 95% CI = 1.05–1.10; P < 0.0001), male sex (HR = 1.55, 95% CI = 1.10–2.16; P = 0.012), and Charlson comorbidity index (HR = 1.28, 95% CI = 1.16–1.40; P < 0.0001).
Surgical treatment of type II odontoid fracture in this elderly population did not negatively impact survival, even after adjusting for age, sex, and comorbidities. The data suggest a significant 30-day survival advantage and a trend toward improved longer-term survival for operatively treated over nonoperatively treated patients.
Level of Evidence: 4
Surgical treatment of type II odontoid fracture in this elderly population did not negatively impact survival, even after adjusting for age, sex, and comorbidities. The data suggest that there is a 30-day survival advantage and a trend toward improved longer-term survival for operatively treated over nonoperatively treated patients.
*Department of Orthopedic Surgery
†Department of Health Services, University of Washington, Seattle, WA
‡Department of Neurosurgery, University of Virginia, Charlottesville, VA
§Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
¶Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS; and
‖Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada
Address correspondence and reprint requests to Justin S. Smith, MD, PhD, Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville VA, 22908; E-mail: email@example.com
Acknowledgment date: June 29, 2012. First revision date: December 16, 2012. Acceptance date: January 4, 2013.
The manuscript submitted does not contain information about medical device(s)/drug(s).
The AOSpine North America Inc., a 501(c) 3 nonprofit corporation's funds were received to support this work.
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