Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges

Anthony O Asemota; A Karim Ahmed; Taylor E Purvis; Peter G Passias; C Rory Goodwin; Daniel M Sciubba

doi:10.1016/j.wneu.2018.07.228

Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges

World Neurosurg. 2018 Dec:120:e114-e130. doi: 10.1016/j.wneu.2018.07.228. Epub 2018 Aug 2.

Authors

Anthony O Asemota¹, A Karim Ahmed¹, Taylor E Purvis¹, Peter G Passias², C Rory Goodwin³, Daniel M Sciubba⁴

Affiliations

¹ Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Division of Spinal Surgery, Department of Orthopaedic Surgery, New York University Medical Center Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA.
³ Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
⁴ Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dsciubb1@jhmi.edu.

PMID: 30077751
DOI: 10.1016/j.wneu.2018.07.228

Abstract

Background: Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking.

Methods: The Nationwide Inpatient Sample 2001-2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using U.S. Census data.

Results: A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74-86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the C2 level (47.6%, P < 0.001) and in CSCI was C1-C4 level (4.5%, P < 0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, P < 0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, P < 0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (P < 0.001).

Conclusions: In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.

Keywords: Cervical spine fractures; Cervical spine surgery; Elderly; Isolated spinal cord injury; Mortality; Odontoid.

MeSH terms

Aged
Aged, 80 and over
Cervical Vertebrae / injuries*
Female
Hospital Charges*
Humans
Incidence
Male
Mortality / trends
Sex Distribution
Spinal Cord Injuries / economics
Spinal Cord Injuries / epidemiology*
Spinal Cord Injuries / mortality
Spinal Fractures / economics
Spinal Fractures / epidemiology*
Spinal Fractures / mortality
United States / epidemiology