title: Occipitocervical Fusions in Elderly Patients: Mortality and Reoperation Rates From a National Spine Registry.
abstract: BACKGROUND
  Several studies have shown excellent fusion rates in occipitocervical (OC) fusions, but very little is reported on mortality and reoperation rates in elderly patients. Our article reports these rates in elderly patients from a national spine registry with a >2-year follow-up period.
  
  
  METHODS
  Using data from a spine implant registry developed at a large integrated health care system (Kaiser Permanente), elderly patients (aged ≥ 65 years) with instrumented OC fusions between January 1, 2009 and September 30, 2013 were identified. Patients' demographics were extracted from the registry. From chart review, the types of hardware and bone graft used, as well as mortality and reoperations rates were noted.
  
  
  RESULTS
  Forty-seven patients with OC fusions were identified. Six patients had reoperations related to their fusions. Two occurred in the same patient, which resulted in a 14.9% reoperation rate. There were a total of 13 deaths (27.7%), with 7 occurring within 3 months, but only 4 (8.5%) related to the procedure. Bone morphogenetic protein was used in 29 patients (85.3%, 29/34). All cases used occipital plates with rods and screws. There was 1 nonunion.
  
  
  CONCLUSIONS
  Mortality rate was 27.7% and the reoperations rate was 14.9% for patients who underwent OC fusions with age >65 years and were observed for >2 years. These numbers are much higher than in younger patients, but reflect a higher mortality due to their comorbidities and from progression of their disease for cases of metastasis to the spine.
authors.affiliation: Kaiser Permanente/Department of Neurosurgery, University of California San Francisco, Sacramento, California, USA. Electronic address: kguppy@yahoo.com.
authors.forename: Kern H
authors.initials: KH
authors.lastname: Guppy
authors.affiliation: Kaiser Permanente/Department of Neurosurgery, University of California San Francisco, Sacramento, California, USA.
authors.forename: Harsimran S
authors.initials: HS
authors.lastname: Brara
authors.affiliation: Kaiser Permanente/Department of Neurosurgery, University of California San Francisco, Sacramento, California, USA.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Bernbeck
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008297:Male; D009777:Occipital Bone; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Bone morphogenetic protein; Elderly patients; Mortality; Nonunions; Occipitocervical fusions; Reoperation