The AOSpine North America geriatric odontoid fracture mortality study: A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up

Jens Chapman, Justin S. Smith, Branko Kopjar, Alexander R. Vaccaro, Paul Arnold, Christopher I. Shaffrey, Michael G. Fehlings

Research output: Contribution to journalReview article

Abstract

Objective. Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. Summary of Background Data. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. Methods. 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. Results. 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). Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)1098-1104
Number of pages7
JournalSpine
Volume38
Issue number13
DOIs
StatePublished - Jun 1 2013
Externally publishedYes

Fingerprint

North America
Geriatrics
Retrospective Studies
Confidence Intervals
Mortality
Comorbidity
Therapeutics
Medical Records
Survival
Sex Distribution
Trauma Centers
Sex Ratio
Enteral Nutrition
Intensive Care Units
Multivariate Analysis
Demography
Databases
Population

Keywords

  • Conservative care
  • Elderly
  • Geriatric
  • Mortality
  • Odontoid fracture
  • Outcomes
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

The AOSpine North America geriatric odontoid fracture mortality study : A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. / Chapman, Jens; Smith, Justin S.; Kopjar, Branko; Vaccaro, Alexander R.; Arnold, Paul; Shaffrey, Christopher I.; Fehlings, Michael G.

In: Spine, Vol. 38, No. 13, 01.06.2013, p. 1098-1104.

Research output: Contribution to journalReview article

Chapman, Jens ; Smith, Justin S. ; Kopjar, Branko ; Vaccaro, Alexander R. ; Arnold, Paul ; Shaffrey, Christopher I. ; Fehlings, Michael G. / The AOSpine North America geriatric odontoid fracture mortality study : A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. In: Spine. 2013 ; Vol. 38, No. 13. pp. 1098-1104.
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abstract = "Objective. Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. Summary of Background Data. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. Methods. 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. Results. 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). Conclusion. 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.",
keywords = "Conservative care, Elderly, Geriatric, Mortality, Odontoid fracture, Outcomes, Surgery",
author = "Jens Chapman and Smith, {Justin S.} and Branko Kopjar and Vaccaro, {Alexander R.} and Paul Arnold and Shaffrey, {Christopher I.} and Fehlings, {Michael G.}",
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TY - JOUR

T1 - The AOSpine North America geriatric odontoid fracture mortality study

T2 - A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up

AU - Chapman, Jens

AU - Smith, Justin S.

AU - Kopjar, Branko

AU - Vaccaro, Alexander R.

AU - Arnold, Paul

AU - Shaffrey, Christopher I.

AU - Fehlings, Michael G.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Objective. Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. Summary of Background Data. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. Methods. 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. Results. 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). Conclusion. 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.

AB - Objective. Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. Summary of Background Data. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. Methods. 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. Results. 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). Conclusion. 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.

KW - Conservative care

KW - Elderly

KW - Geriatric

KW - Mortality

KW - Odontoid fracture

KW - Outcomes

KW - Surgery

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