Identifying factors influencing mortality in patients aged over 65 following an acute type II odontoid process fracture. A retrospective cohort study

摘要

Objective Compare short-term mortality rates following operative and nonoperative management of geriatric patients following an acute type II odontoid process fracture. Methods One hundred forty-one patients with a type II odontoid fracture were identified from a single centre between 2002 and 2018. Patient demographics, details of injury and management, plus mortality data were collected. The incidence of mortality at 3 and 12 months was calculated, and a multivariate model built which included the treatment modality variable and allowed adjustment for six individual confounders. Results Of the 141 patients with a type II odontoid process fracture, 39 were managed operatively, while 102 were managed nonoperatively. Relative to the nonoperative group, the operative group was younger (79.0 +/- 7.0 vs. 83.7 +/- 7.6), more likely to have odontoid angulation > 15 degrees (74.4 vs. 43.1, p 2 mm (74.4 vs. 31.4, p < 0.01). Both groups were comparable for gender, comorbidities, and associated injuries. On univariate analysis of treatment modality, the odds ratio of 3-month mortality with nonoperative management was 2.55 (95 CI: 0.82-7.92; p = 0.08), whilst at 12-months it was 3.12 (95 CI: 1.11-8.69; p = 0.02). On multivariate analysis of 12-month mortality, however, treatment modality was not found to be significant. This multivariate analysis suggested that increasing age, male gender, and injury severity were significant predictors of 12-month mortality. Conclusion In contrast to the findings of a number of previous studies, operative management may not influence survival at 3- and 12-months.