title: Early Morbidity and Mortality in 50 Very Elderly Patients After Posterior Atlantoaxial Fusion for Traumatic Odontoid Fractures.
abstract: BACKGROUND
  Traumatic odontoid fractures (tOFs) in the very elderly are associated with high morbidity and mortality. The best treatment strategy (conservative vs. surgery) is still unclear.
  
  
  METHODS
  Between April 2008 and April 2014, fifty (17 male, 33 female) patients (mean age 87.2 ± 4.4 years; range: 80-99) were included in this retrospective cohort study. All patients underwent posterior fusion surgery for tOF. Early outcome, morbidity and mortality, length of hospital and intensive care unit (ICU) stay, comorbidities, and perioperative complications were assessed.
  
  
  RESULTS
  The mean age-adjusted Charlson Comorbidity Index (CCI) was 5.8 ± 3.9 (range: 0-13), and the mean American Society of Anesthesiologists score was 3 ± 0.5 (range: 2-4). Surgery was delayed in 48% of patients. Thirty percent of patients had preoperative complications (72.4% severe), of which a leading cause was dysphagia with subsequent pneumonia, and 18% required preoperative assessment or improvement of health status. Surgery-related complications were experienced in 14% with no neurovascular lesion. Postoperative medical complications occurred in 52% of patients (67.3% severe). Major complications were mostly respiratory/pulmonary (66.7%), of which postoperative pneumonia (36.4%) was leading. Twenty-four percent of patients were ICU monitored. Mean length of ICU stay was 9 ± 6.6 days (1-20). Mean length of hospital stay was 15 ± 8.6 days (4-56). There was no in-hospital mortality, and 30-day mortality was 6%.
  
  
  CONCLUSIONS
  Posterior fusion for tOF in patients 80 years or older seems to be a feasible treatment option in these high-risk patients. Despite a high incidence of severe comorbidities and perioperative complications, outcome was satisfactory.
  
  
  METHODS
  Our research was a retrospective cohort study, Level III.
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: yu.ryang@tum.de.
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Ryang
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Török
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Insa
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reinke
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Buchmann
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
mesh_terms: D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D009809:Odontoid Process / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000401:mortality* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000401:mortality*; D016896:Treatment Outcome
keywords: Comorbidities; Early morbidity and mortality; Posterior atlantoaxial fusion; Traumatic odontoid fracture; Very elderly