TY - JOUR
T1 - Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database
T2 - Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges
AU - Asemota, Anthony O.
AU - Ahmed, A. Karim
AU - Purvis, Taylor E.
AU - Passias, Peter G.
AU - Goodwin, C. Rory
AU - Sciubba, Daniel M.
N1 - Funding Information:
Conflict of interest statement: Peter G. Passias is a consultant for Medicrea and has speaking and/or teaching arrangements for Zimmer Biomet. C. Rory Goodwin received a United Negro College Fund Merck Postdoctoral Fellowship and has received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. Daniel M. Sciubba is a consultant for Medtronic, DePuy-Synthes, Stryker, Nuvasive, and Baxter.
Funding Information:
Conflict of interest statement: Peter G. Passias is a consultant for Medicrea and has speaking and/or teaching arrangements for Zimmer Biomet. C. Rory Goodwin received a United Negro College Fund Merck Postdoctoral Fellowship and has received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. Daniel M. Sciubba is a consultant for Medtronic, DePuy-Synthes, Stryker, Nuvasive, and Baxter.
Publisher Copyright:
© 2018
PY - 2018/12
Y1 - 2018/12
N2 - Background: Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking. Methods: The Nationwide Inpatient Sample 2001–2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using U.S. Census data. Results: A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74–86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the C2 level (47.6%, P < 0.001) and in CSCI was C1–C4 level (4.5%, P < 0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, P < 0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, P < 0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (P < 0.001). Conclusions: In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.
AB - Background: Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking. Methods: The Nationwide Inpatient Sample 2001–2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using U.S. Census data. Results: A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74–86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the C2 level (47.6%, P < 0.001) and in CSCI was C1–C4 level (4.5%, P < 0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, P < 0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, P < 0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (P < 0.001). Conclusions: In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.
KW - Cervical spine fractures
KW - Cervical spine surgery
KW - Elderly
KW - Isolated spinal cord injury
KW - Mortality
KW - Odontoid
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U2 - 10.1016/j.wneu.2018.07.228
DO - 10.1016/j.wneu.2018.07.228
M3 - Article
C2 - 30077751
AN - SCOPUS:85053719319
SN - 1878-8750
VL - 120
SP - e114-e130
JO - World neurosurgery
JF - World neurosurgery
ER -