Kukreja Sunil, Kalakoti Piyush, Murray Richard, Nixon Menarvia, Missios Symeon, Guthikonda Bharat, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana.
Neurosurg Focus. 2015 Apr;38(4):E19. doi: 10.3171/2015.1.FOCUS14825.
Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database.
The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: < 65 years, 65-80 years, and > 80 years. Incidence, treatment characteristics, inpatient/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups.
A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (> 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in < 65-year age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and > 80-year age groups (p < 0.001). However, the incidence did not change substantially in the < 65-year age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p < 0.001). Regardless of treatment given, patients in older age groups had a greater risk of inpatient/postoperative complications, nonroutine discharges, and longer hospitalization. The mean hospital charges were significantly higher in older age groups (p < 0.001).
The incidence of hospitalization for isolated C-2 fractures is progressively increasing in older age groups. Simultaneously, there has been a steadily decreasing trend in the preference for nonoperative interventions. Due to more complicated hospital stay, longer hospitalizations, and higher rates of nonroutine discharges, the patients in older age groups seem to have a higher propensity for greater health care resource utilization.
老年患者中C2骨折的发生率正在上升。患者年龄也会影响这些骨折治疗方案的决策。关于不同年龄组孤立性C2骨折患者的发病率、治疗干预措施和资源利用的全国性趋势的数据非常有限。本研究的目的是利用全国住院患者样本（NIS）数据库调查3个不同年龄组患者孤立性C2骨折的发病率、治疗情况、并发症、住院时间和住院费用。
数据取自2002年至2011年的NIS。使用ICD-9-CM诊断代码805.02提取无脊髓损伤的C2闭合性骨折患者的数据。通过排除其他合并损伤的患者来确定孤立性C2骨折患者。该队列分为3个年龄组：<65岁、65 - 80岁和>80岁。比较3个年龄组之间的发病率、治疗特征、住院/术后并发症和住院费用（平均和年度总费用）。
共确定10336例孤立性C2骨折患者。大多数患者属于高龄组（>80岁；42.3%），其次是65至80岁年龄组的29.7%和<65岁年龄组的28%。从2002年到2011年，65至80岁和>80岁年龄组的住院发病率显著增加（p<0.001）。然而，<65岁年龄组的发病率没有实质性变化（p = 0.287）。总体而言，21%的患者接受了手术治疗，12.2%的患者接受了非手术干预（头环和脊柱牵引）。所有年龄组的非手术干预率均随时间显著下降（p<0.001）。无论接受何种治疗，老年组患者发生住院/术后并发症、非常规出院和住院时间更长的风险更高。老年组的平均住院费用显著更高（p<0.001）。
老年组孤立性C2骨折的住院发病率在逐渐增加。同时，对非手术干预的偏好呈稳步下降趋势。由于住院情况更复杂、住院时间更长以及非常规出院率更高，老年组患者似乎有更高的倾向使用更多的医疗资源。
