Abstract：
OBJECTIVE: Second cervical vertebrae (C2) fractures are a common traumatic spinal injury in the elderly population. Surgical fusion and nonoperative bracing are two primary treatments for cervical instability, but the former is often withheld in the elderly due to concerns for poor postoperative outcomes arising from patient frailty. This study sought to evaluate the in-hospital differences in mortality, outcomes, and discharge disposition in elderly patients with C2 fractures undergoing surgical intervention compared with conservative therapy.
METHODS: The National Trauma Data Bank was queried from 2017 to 2019 for all patients aged ≥ 65 years with C2 fractures undergoing either surgical stabilization or conservative therapy. Propensity score matching was performed using k-nearest neighbors with replacement based on patient demographics, comorbidities, insurance type, injury severity, and fracture type. Group differences were compared using Student t-tests and Pearson\'s chi-square tests with Benjamini-Hochberg multiple comparisons correction. Subgroup analyses were performed in the 65-74, 75-79, and 80+ year age subgroups.
RESULTS: Six thousand forty-nine patients were identified, of whom 2156 underwent surgery and 3893 received conservative treatment. Following matching, the surgery group had significantly lower mortality rates (5.52% vs 9.6%, p < 0.001), a longer mean hospital length of stay (LOS; 12.64 vs 7.49 days p < 0.001), and slightly higher rates of several complications (< 3% difference), as well as lower rates of discharge home (14.56% vs 23.52%, p < 0.001) and to hospice (1.07% vs 2.09%, p = 0.02) and a higher rate of discharge to intermediate care (68.83% vs 48.28%, p < 0.001). Similar trends in mortality and LOS were noted in all 3 subgroups.
CONCLUSIONS: In elderly patients with C2 fractures, surgical stabilization confers a small survival advantage with a slightly higher in-hospital complication rate compared to conservative therapy. The increased rate of discharge to rehabilitation may represent better long-term prognosis following surgery. The increased risk of short-term complications is present but relatively small, thus surgery should not be withheld in patients with good long-term prognosis.
METHODS: The National Trauma Data Bank was queried from 2017 to 2019 for all patients aged ≥ 65 years with C2 fractures undergoing either surgical stabilization or conservative therapy. Propensity score matching was performed using k-nearest neighbors with replacement based on patient demographics, comorbidities, insurance type, injury severity, and fracture type. Group differences were compared using Student t-tests and Pearson\'s chi-square tests with Benjamini-Hochberg multiple comparisons correction. Subgroup analyses were performed in the 65-74, 75-79, and 80+ year age subgroups.
RESULTS: Six thousand forty-nine patients were identified, of whom 2156 underwent surgery and 3893 received conservative treatment. Following matching, the surgery group had significantly lower mortality rates (5.52% vs 9.6%, p < 0.001), a longer mean hospital length of stay (LOS; 12.64 vs 7.49 days p < 0.001), and slightly higher rates of several complications (< 3% difference), as well as lower rates of discharge home (14.56% vs 23.52%, p < 0.001) and to hospice (1.07% vs 2.09%, p = 0.02) and a higher rate of discharge to intermediate care (68.83% vs 48.28%, p < 0.001). Similar trends in mortality and LOS were noted in all 3 subgroups.
CONCLUSIONS: In elderly patients with C2 fractures, surgical stabilization confers a small survival advantage with a slightly higher in-hospital complication rate compared to conservative therapy. The increased rate of discharge to rehabilitation may represent better long-term prognosis following surgery. The increased risk of short-term complications is present but relatively small, thus surgery should not be withheld in patients with good long-term prognosis.
摘要：
目的：第二颈椎（C2）骨折是老年人群常见的创伤性脊柱损伤。手术融合和非手术支撑是颈椎不稳的两种主要治疗方法，但由于担心患者虚弱引起的术后不良结果，老年人经常拒绝前者。这项研究试图评估医院内死亡率的差异，结果，与保守治疗相比，接受手术干预的老年C2骨折患者的出院情况。
方法：从2017年至2019年，国家创伤数据库查询了所有年龄≥65岁的C2骨折接受手术稳定或保守治疗的患者。使用k个最近邻居进行倾向评分匹配，并根据患者的人口统计进行替换，合并症,保险类型,损伤严重程度,和骨折类型。使用Studentt检验和Pearson卡方检验以及Benjamini-Hochberg多重比较校正来比较组差异。在65-74、75-79和80岁以上的亚组中进行亚组分析。
结果：确认了六千四十九名患者，其中2156人接受了手术，3893人接受了保守治疗。匹配后，手术组的死亡率显着降低（5.52％vs9.6％，p<0.001)，平均住院时间较长(LOS；12.64vs7.49天，p<0.001)，几种并发症的发生率略高（差异<3％），以及较低的出院率(14.56%对23.52%，p<0.001)和临终关怀(1.07%vs2.09%，p=0.02）和更高的出院率（68.83％vs48.28％，p<0.001)。在所有3个亚组中，死亡率和LOS的趋势相似。
结论：在老年C2骨折患者中，与保守治疗相比,手术稳定带来的生存优势较小,院内并发症发生率略高.康复出院率的增加可能代表手术后更好的长期预后。短期并发症的风险增加，但相对较小，因此，长期预后良好的患者不应停止手术。
方法：从2017年至2019年，国家创伤数据库查询了所有年龄≥65岁的C2骨折接受手术稳定或保守治疗的患者。使用k个最近邻居进行倾向评分匹配，并根据患者的人口统计进行替换，合并症,保险类型,损伤严重程度,和骨折类型。使用Studentt检验和Pearson卡方检验以及Benjamini-Hochberg多重比较校正来比较组差异。在65-74、75-79和80岁以上的亚组中进行亚组分析。
结果：确认了六千四十九名患者，其中2156人接受了手术，3893人接受了保守治疗。匹配后，手术组的死亡率显着降低（5.52％vs9.6％，p<0.001)，平均住院时间较长(LOS；12.64vs7.49天，p<0.001)，几种并发症的发生率略高（差异<3％），以及较低的出院率(14.56%对23.52%，p<0.001)和临终关怀(1.07%vs2.09%，p=0.02）和更高的出院率（68.83％vs48.28％，p<0.001)。在所有3个亚组中，死亡率和LOS的趋势相似。
结论：在老年C2骨折患者中，与保守治疗相比,手术稳定带来的生存优势较小,院内并发症发生率略高.康复出院率的增加可能代表手术后更好的长期预后。短期并发症的风险增加，但相对较小，因此，长期预后良好的患者不应停止手术。
