Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury.

• 影响指数: 4.332
• 发表时间: 03 2019 1
• 来源期刊: Neurosurg Focus
• DOI: 10.3171/2018.12.FOCUS18555
• PMID: 30835676
• 文章类型: Journal Article
• 中科院分区: Q2
• 方向: 医学
• 作者列表: Lau D,Dalle Ore CL,Tarapore PE,Huang M,Manley G,Singh V,Mummaneni PV,Beattie M,Bresnahan J,Ferguson AR,Talbott JF,Whetstone W,Dhall SS

关键词: AIS = American Spinal Injury Association Impairment Scale; AKI = acute kidney injury; BASIC = Brain and Spinal Injury Center; DVT = deep vein thrombosis; GCS = Glasgow Coma Scale; ICU = intensive care unit; LOS = length of stay; MAP = mean arterial pressure; PE = pulmonary embolus; SCI = spinal cord injury; SNF = subacute nursing facility; TBI = traumatic brain injury; UTI = urinary tract infection; VCR = vertebral column resection; age; complications; elderly; morbidity; mortality; spinal cord injury; trauma

Mesh: Adult; Age Factors; Aged; Aged, 80 and over; Critical Care; Decompression, Surgical; Female; Fracture Dislocation / complications; Hemorrhage / etiology; Hospital Mortality; Humans; Intensive Care Units; Length of Stay / statistics & numerical data; Male; Middle Aged; Postoperative Complications / epidemiology etiology; Prognosis; Quality of Life; Recovery of Function; Retrospective Studies; Spinal Cord Injuries / complications surgery; Spinal Fractures / complications; Spinal Fusion; Treatment Outcome

Abstract

OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.