188 Morbidity and Mortality Associated With Operative Management of Traumatic C2 Fractures in Octogenarians

Abstract INTRODUCTION: The management of axis fractures and particularly of odontoid fractures in the elderly remains controversial. As a greater segment of the US population lives past 80, it is becoming increasingly evident that published morbidity and mortality profiles of C2 fractures in younger cohorts (55+) are not applicable to octogenarians. Consequently, there is a need for further study in this specific population. METHODS: Using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), we performed a retrospective analysis of patients with age = 80 years and traumatic C2 fracture. Demographics, inpatient complications, and the outcome end points of mortality, hospital length of stay (LOS), and discharge disposition were described between nonoperative and operative cohorts. Multivariable regression analyses were performed. RESULTS: From 2003 to 2012, 3847 people met inclusion criteria, which represents 17 702 incidents nationally. The overall incidence of operative management was 10.3%. Operative management was associated with increased risk of pneumonia (10.1% vs 5.9%, P < .001), acute respiratory distress syndrome (6.0% vs 2.3%, P < .001), and decubitus ulcer (4.8% vs 1.3%, P < .001). Inpatient mortality was 12.8% for all subjects and was not significantly different between nonoperative and operative cohorts (nonoperative 13%; operative 10.3%; P = .120). Overall hospital LOS was 8.31 ± 9.32 days (nonoperative 7.78 ± 9.21; operative 12.86 ± 9.07; P < .001) and showed an adjusted mean increase of 5.68 days with operative management (95% confidence interval [CI], 4.74-6.61). Of patients who survived to discharge, 26% returned home (nonoperative 26.8%; operative: 18.8%; P = .001). Patients who underwent operative management were less likely to return home (odds ratio, 0.59; 95% CI, 0.44-0.78). CONCLUSION: The present study confirms that operative management of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases the rate of discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and experience higher rates of medical complications during their stay.