This study used only de-identified retrospective patient data, and individual participant informed consent was waived by the Unity Health Toronto Research Ethics Board. Study procedures were followed in accordance with the ethical standards of the institutional committee on human experimentation and with the Helsinki Declaration of 1975. This study number 20–338 was approved by the Unity Health Toronto Research Ethics Board (Toronto, Ontario, Canada) in February of 2021. The study design was a multicenter retrospective cohort study. The objective of this study was to determine the association between surgical management of odontoid fractures and in-hospital mortality and complications in a large multi-center cohort of geriatric patients. In this study we conducted a retrospective analysis using data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP). While most previous studies have used data gathered at a single institution, few have examined a multi-center cohort 4, 17. In contrast others have advocated that non-operative management is an acceptable treatment option despite lower rates of osseous union 11, 18. A prospective study comparing surgical fixation with non-operative treatment found a trend toward lower mortality in patients treated surgically 21. Previous retrospective studies have found surgical treatment of geriatric odontoid fractures to be associated with lower mortality at 30 days when compared to non-operative treatment 17, 18, 19, 20. Surgery, however, is associated with high peri-operative risks given the prevalence of poor bone health and medical comorbidities in an elderly population 14, 15, 16. Non-operative treatment is associated with a risk of fibrous non-union and high 1-year mortality 8, 9, 10, 11, 12, 13. Given the rapid expansion of this population and this high incidence of odontoid fractures, geriatric spine fractures have been described as an emerging health crisis 6.ĭespite the increasing frequency of these fractures there remains uncertainty about the optimal management strategy 7. The number of individuals over 65 years of age in the United States is expected to increase faster than any other age group to over 70 million in the next decade 5. Surgical management of geriatric patients with odontoid fractures requires careful patient selection and consideration of pre-existing comorbidities.įractures of the C2 odontoid process are the most common isolated spine fracture in geriatric patients and are associated with high morbidity and mortality 1, 2, 3, 4. Among geriatric patients with odontoid fractures surgical management was associated with similar in-hospital mortality, but higher in-hospital complication rates compared to non-operative management. These findings were supported by secondary analyses that considered between-center differences in rates of surgery. Patients undergoing surgery had extended in-hospital length of stay compared to the non-operative group (9 days, IQR: 6–12 days vs. The risks of major complications and immobility-related complications were higher in the operative cohort (adjusted OR: 2.12, 95%CI: 1.53–2.94 and OR: 2.24, 95%CI: 1.38–3.63, respectively). The risk of in-hospital mortality did not differ between surgical and non-surgical groups, after patient and hospital-level adjustment (OR: 0.94, 95%CI: 0.55–1.60). Among the 13,218 eligible patients, 1100 (8.3%) were treated surgically. Generalized estimating equation models were used to compare outcomes between operative and non-operative cohorts. Secondary outcomes were in-hospital complications and hospital length of stay. The primary study outcome was in-hospital mortality. We identified patients 65 years or older with C2 odontoid fractures from the Trauma Quality Improvement Program database.
Our study aims to investigate the association between surgical management of odontoid fractures and in-hospital mortality in a multi-center geriatric cohort. Optimal management remains controversial. Odontoid fractures are increasingly prevalent in older adults and associated with high morbidity and mortality.
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