title: Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians.
abstract: BACKGROUND
  Management of axis fractures in the elderly remains controversial. As the US population increasingly lives past 80 years, published C2 fracture morbidity/mortality profiles in younger cohorts (55+) have become less applicable to octogenarians.
  
  
  OBJECTIVE
  To report associations between surgery and mortality, hospital length of stay and discharge disposition in octogenarians with traumatic C2 fractures.
  
  
  METHODS
  Retrospective cohort study of 3847 patients age ≥ 80 years representing 17 702 incidents nationwide, divided into surgery/nonsurgery cohorts, using the National Sample Program of the National Trauma Data Bank from 2003 to 2012. Inpatient complications, mortality, length of stay, and discharge disposition are characterized; multivariable regression was utilized to determine associations between surgery and outcomes.
  The National Sample Program dataset from the National Trauma Data Bank is fully deidentified and does not contain Health Insurance Portability and Accountability Act identifiers; therefore, this study is exempt from IRB review at the University of California, San Francisco.
  
  
  RESULTS
  Incidence of surgery was 10.3%. Surgery was associated with increased pneumonia, acute respiratory distress syndrome, and decubitus ulcer risks ( P < .001). Inpatient mortality was 12.8% (nonsurgery-13.0%; surgery-10.3%; P = .120). Length of stay was 8.31 ± 9.32 days (nonsurgery 7.78 ± 9.21; surgery 12.86 ± 9.07; P < .001) and showed an adjusted mean increase of 5.68 days with surgery (95% confidence interval [4.74-6.61]). Of patients surviving to discharge, 26% returned home (nonsurgery-26.8%; surgery-18.8%; P = .001); surgery patients were less likely to return home (odds ratio 0.59 [0.44-0.78]).
  
  
  CONCLUSIONS
  The present study confirms that surgery of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer increased medical complications during their stay. Given the retrospective nature of this study, it is unclear whether these conclusions reflect differences in injury severity between surgery cohorts. This question may be considered in a future prospective study.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Dhall
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Phiroz E
authors.initials: PE
authors.lastname: Tarapore
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012495:San Francisco; D016103:Spinal Fractures / Q000401:mortality* / Q000601:surgery*
keywords: Axis fracture; Cervical spine fracture; Elderly; Odontoid fracture; Trauma