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Original article
Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
  1. Laura N Godat1,
  2. Leslie M Kobayashi1,
  3. David C Chang2,
  4. Raul Coimbra3
  1. 1Department of Surgery, University of California, San Diego Health Sciences, San Diego, California, USA
  2. 2Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Surgery, Riverside University Health System, Moreno Valley, California, USA
  1. Correspondence to Dr Laura N Godat, Department of Surgery, University of California, San Diego Health Sciences, San Diego, CA 92103, USA; lgodat{at}ucsd.edu

Abstract

Background Elderly patients with cervical spine fractures require optimal care. Treatment with a cervical collar or halo instead of surgical fixation may increase mortality. This investigation intends to describe the life expectancy after injury and evaluate the impact of surgical intervention on mortality.

Methods Patients ≥65 years, with traumatic cervical spine fractures without cord injury were identified in the 1995–2009 California Office of Statewide Health and Planning database. Those with halo placement or surgical spine fixation were identified. Primary outcome was death, studied at the initial admission, 30 days, 1 year, and the entire study period. Univariate and multivariate regressions were performed to identify predictors of death. Kaplan-Meier survival curves were used to describe life expectancy after injury.

Results 10 938 patients were identified. Mortality rate was 10% during the initial admission, 28% at 1 year and 50% during the entire study period. A halo was placed in 14% of patients and 12% underwent surgical fixation. Mortality rates during the initial admission were 11% for patients without an intervention, 7% with halo placement and 6% with surgical fixation; at 1 year, these increased to 30%, 26% and 19%, respectively. At 1 year, more than one in four patients above 75 years of age will die.

At 1 year spine fixation, female gender and admission to a trauma center predicted a lower risk of death at 1 year (OR 0.59, 0.68; p<0.001 and OR 0.89; p=0.02, respectively). Having a complication, fall mechanism, and traumatic brain injury (OR 1.84, 1.33, 1.37; p<0.001, respectively) were predictors of a higher risk of death. Halo use had no impact on death at 1 year (OR 0.98; p=0.77).

Discussion Mortality rates after cervical spine fracture in the elderly is high. Surgical fixation is associated with improved survival; remaining true after adjusting for age and comorbidities; suggesting that surgical fixation may improve outcomes in the elderly.

Level of evidence Level IV.

  • elderly patients
  • cervical spine
  • outcomes research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2018-000174

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    Footnotes

    • Contributors LNG, LMK and DCC contributed to study design, data collection, data analysis and data interpretation. LNG, LMK and RC were responsible for manuscript writing. DCC and RC were responsible for the critical revision of the article. RC contributed to data interpretation too.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at This was presented at American Association for the Surgery of Trauma. Poster presentation September 2015 Las Vegas, Nevada, USA.