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

Abstract

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° (74.4% vs. 43.1%, p < 0.01), and a greater proportion having fracture displacement > 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.

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Availability of data and materials

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Lukins, T., Nguyen, L., Hansen, M.A. et al. Identifying factors influencing mortality in patients aged over 65 following an acute type II odontoid process fracture. A retrospective cohort study. Eur Spine J 30, 1551–1555 (2021). https://doi.org/10.1007/s00586-020-06694-z

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  • DOI: https://doi.org/10.1007/s00586-020-06694-z

Keywords

  • Odontoid process
  • Spinal fracture
  • Aged
  • Mortality