Departments of1Neurological Surgery.
2San Francisco General Hospital; and.
Neurosurg Focus. 2019 Mar 1;46(3):E3. doi: 10.3171/2018.12.FOCUS18555.
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.
老年人是创伤性脊髓损伤（SCI）患者中不断增长的亚群。研究报告称，接受 SCI 手术治疗的老年患者发病率和死亡率较高。在这项研究中，作者比较了接受手术治疗的老年 SCI 患者与年轻患者以及文献报道的患者的围手术期结局。
回顾性分析了 2007 年至 2017 年期间在一家机构接受连续系列成人创伤性 SCI 手术治疗的患者数据。根据年龄将队列分为两组：小于 70 岁和 70 岁或以上。评估的结果包括并发症、院内死亡率、重症监护病房（ICU）停留时间、住院时间（LOS）、处置和神经状态。
共纳入 106 例患者：83 例为年轻患者，23 例为老年患者。两组在影像学特征（脊髓出血和骨折）、手术技术和美国脊髓损伤协会损伤分级（AIS）方面相似。老年患者颈椎 SCI 的比例明显更高（95.7%比 71.1%，p=0.047）。年轻患者和老年患者在 ICU 停留时间（分别为 13.1 天和 13.3 天，p=0.948）和住院 LOS（分别为 23.3 天和 21.7 天，p=0.793）方面无显著差异。老年患者的并发症发生率（73.9%比 43.4%，p=0.010）和死亡率（13.0%比 1.2%，p=0.008）明显更高；换句话说，老年患者的并发症发生率和死亡率分别是年轻患者的 1.7 倍和 10.8 倍。没有老年患者出院回家（0.0%比 18.1%，p=0.029）。两组出院 AIS 分级和 AIS 分级变化相似。
老年患者的并发症和死亡率高于年轻患者，出院回家的可能性较低。然而，与之前的历史报告相比，死亡率似乎有所改善。
