Using Frailty Measures to Predict Functional Outcomes and Mortality After Type II Odontoid Fracture in Elderly Patients: A Retrospective Cohort Study.

Autor:	Hamrick FA; School of Medicine, University of Utah, Salt Lake City, UT, USA., Sherrod BA; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA., Cole K; School of Medicine, University of Utah, Salt Lake City, UT, USA., Cox P; School of Medicine, University of Utah, Salt Lake City, UT, USA., Croci DM; Department of Neurosurgery, University of South Florida, Tampa, FL, USA., Bowers CA; Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA., Mazur MD; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA., Dailey AT; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA., Bisson EF; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2024 Jun; Vol. 14 (5), pp. 1552-1562. Date of Electronic Publication: 2023 Jan 10.
DOI:	10.1177/21925682221149394
Abstrakt:	Study Design: Single-center retrospective cohort study. Objectives: Type II odontoid fractures occur disproportionately among elderly populations and cause significant morbidity and mortality. It is a matter of debate whether these injuries are best managed surgically or conservatively. Our goal was to identify how treatment modalities and patient characteristics correlated with functional outcome and mortality. Methods: We identified adult patients (>60 years) with traumatic type II odontoid fractures. We used multivariate regression controlling for patient demographics, Glasgow Coma Scale (GCS) score, Charlson Comorbidity Index (CCI), modified Rankin Scale (mRS) score, modified Frailty Index (mFI-5 and mFI-11), fracture displacement, and conservative vs operative treatment. Results: Of the 59 patients (mean age 77.9 years), 24 underwent surgical intervention and 35 underwent conservative management. Operatively managed patients were younger (73.4 vs 80.6 years, P < .001) and had higher degree of fracture displacement (3.5 vs 1.0 mm, P = .002) than conservatively managed patients but no other differences in baseline characteristics. Twenty-four patients (40.7%) died within the study period (median time to death: 376 days). There were no differences between treatment groups in functional outcomes (mRS or Frankel Grade) or mortality (33.3% in operative group vs 45.7%, P = .34). There was a statistically significant correlation between higher presentation mRS score and subsequent mortality on multivariate analysis (OR = 2.06, 95% CI 1.04-4.10, P = .039), whereas surgical intervention, age, GCS score, CCI, mFI-5, mFI-11, sex, and fracture displacement were not significantly correlated. Conclusions: Mortality after type II odontoid fractures in elderly patients is common. mRS score at presentation may help predict mortality more accurately than other patient factors. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Dailey is a consultant for Zimmer Biomet Spine. Dr. Bisson is a consultant for MiRus, Stryker Spine, and nView and has equity interest in MiRus. The other authors have no potential conflicts to report.
Databáze:	MEDLINE
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