Predictors of 30-day outcomes in octogenarians with traumatic C2 fractures present process surgical procedure.
World Neurosurg. 2018 Jun 07;:
Authors: Yue JK, Ordaz A, Winkler EA, Deng H, Suen CG, Burke JF, Chan AK, Manley GT, Dhall SS, Tarapore PE
OBJECTIVE: Predictors of surgical outcomes following traumatic axis (C2) fractures in octogenarians stay undercharacterized.
METHODS: Sufferers aged ?80-years present process cervical backbone surgical procedure following traumatic C2 fractures have been extracted from the Nationwide Pattern Program of the Nationwide Trauma Information Financial institution (2003-2012). Outcomes embrace general inpatient problems, particular person problems >1% incidence, hospital size of keep (HLOS), discharge disposition, and mortality. Demographics, comorbidities, and damage predictors have been analyzed utilizing multivariable regression. Odds ratios (OR), imply variations, and 95% confidence intervals (CI) have been calculated. Statistical significance was assessed at p<zero.05.
RESULTS: In 442 sufferers, imply age was 84.three±2.7-years and 48.6% have been male. Admissions have been 42.three%-hospital ground, 40.three%-intensive care unit (ICU), 7.7%-telemetry, 2.zero%-operating room, and seven.7%-other/unknown. Mortality was 9.7%, HLOS 13.1±9.2-days, 38.5% suffered problems, and 81.5% of survivors have been discharged to a non-home facility. Harm severity predicted mortality and general problems. Historical past of bleeding dysfunction/coagulopathy predicted mortality (OR=four.02, 95% CI [1.07-15.05]), general problems (OR=three.01 [1.09-8.32]), cardiac arrest (OR=eight.19 [1.06-63.54]) and renal problems (OR=10.36 [2.13-50.38]). Historical past of congestive coronary heart failure predicted mortality (OR=three.10 [1.10-8.69]). ICU admission (vs. ground) predicted general problems (OR=2.01 [1.23-3.27]) and pneumonia (OR=four.65 [1.91-11.30]). Telemetry admission (vs. ground) predicted unplanned intubation (OR=7.76 [1.24-48.49]).
CONCLUSIONS: On this cohort of octogenarians present process surgical procedure for traumatic C2 fracture, damage severity and historical past of bleeding dysfunction/coagulopathy have been threat elements for inpatient problems and mortality. Heightened surveillance ought to be thought of for ICU and/or telemetry admissions for the event of problems. These findings warrant consideration by the clinician, affected person and household to tell medical choices and targets of care.
PMID: 29886301 [PubMed – as supplied by publisher]