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.
METHODS
Retrospective, multicenter cohort study.


OBJECTIVE
Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures.


BACKGROUND
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).


CONCLUSIONS
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.


METHODS
4.
Department of Orthopedic Surgery, University of Washington, Seattle, WA, USA.
Jens
J
Chapman
Justin S
JS
Smith
Branko
B
Kopjar
Alexander R
AR
Vaccaro
Paul
P
Arnold
Christopher I
CI
Shaffrey
Michael G
MG
Fehlings
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009656:North America; D009809:Odontoid Process / Q000293:injuries*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D013124:Spinal Injuries / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome