title: Mortality in elderly patients following operative and nonoperative management of odontoid fractures.
abstract: METHODS
  Retrospective matched cohort study.
  
  
  OBJECTIVE
  To compare mortality in elderly patients with odontoid fractures after operative and nonoperative treatment. In addition, to evaluate potential factors that may increase the risk of mortality in the geriatric population after odontoid fracture.
  
  
  BACKGROUND
  Odontoid fractures represent the most common cervical spine fracture in patients over 70. In this population controversy exists as to the optimal treatment of odontoid fractures, especially type II fractures.
  
  
  METHODS
  A retrospective review of all odontoid fractures in patients 75 years of age or older at our institution from 1996 to 2010 was performed. Comorbidities were stratified using the Charlson comorbidity index. Mortality was determined at 3 months, 1, and 5 years.
  
  
  RESULTS
  A total of 96 patients were identified of which 75 met inclusion criteria. The average age of patients included was 82.3 years. The average Charlson comorbidity score for those operated on (2.37) was not significantly different from the nonoperative group (2.46), (P=0.45). At 3 months the operative group had a significantly lower mortality rate than the nonoperative group (P=0.024). There was no significant difference in 1-year (P=0.42) or 5-year (P=0.21) mortality between the operative and nonoperative cohorts. Of the patients treated nonoperatively, those who died within 3 months of treatment had a significantly higher Charlson score (3.98) than those who survived (2.14). Patients who survived at least 1 year after surgery had a significantly lower Charlson score (1.53) than those who died (3.22) within that time frame after surgery (P=0.05).
  
  
  CONCLUSIONS
  There was no significant difference between 1- and 5-year mortality in patients treated operatively or nonoperatively. Regardless of treatment Charlson score had a significant impact on mortality. Age significantly affected mortality in patients treated surgically.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Barrett I
authors.initials: BI
authors.lastname: Woods
authors.forename: Justin B
authors.initials: JB
authors.lastname: Hohl
authors.forename: Brett
authors.initials: B
authors.lastname: Braly
authors.forename: William
authors.initials: W
authors.lastname: Donaldson
authors.forename: James
authors.initials: J
authors.lastname: Kang
authors.forename: Joon Yung
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016103:Spinal Fractures / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology