Kopp Marcel A, Lübstorf Tom, Blex Christian, Schwab Jan M, Grittner Ulrike, Auhuber Thomas, Ekkernkamp Axel, Niedeggen Andreas, Prillip Erik, Hoppe Magdalena, Ludwig Johanna, Kreutzträger Martin, Liebscher Thomas
Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research, Berlin, Germany.
Eur Spine J. 2022 Jan;31(1):56-69. doi: 10.1007/s00586-021-06982-2. Epub 2021 Sep 17.
To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI).
Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression.
The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85-9.65), as mirrored by adjusted spline curves (< 20 h 20-25%, 20-60 h 10-20%, > 60 h < 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02-0.44) for'45-59y' vs.' ≤ 44y'], as confirmed by spline curves (< 40y 20-80%, ≥ 40y 5-20% probability).
Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.
探讨年龄与脊柱手术延迟之间的关联以及对创伤性脊髓损伤（SCI）后神经功能结局的影响。
对德国大都市地区一家一级创伤中心连续收治的213例接受SCI治疗的患者进行双向队列研究（2011 - 2017年）。采用年龄分组或连续变量以及自然立方样条函数，探讨损伤至手术间隔时间的年龄相关差异及其延迟（SCI后>12小时）相关情况。使用多因素逻辑回归分析延迟手术或年龄对结局的影响。
研究人群的中位年龄为58.8岁（四分位间距42.0 - 74.6岁）。与年轻患者（≤44岁）的6.6小时（4.4 - 47.9小时）相比，老年患者（≥75岁）的损伤至手术间隔时间延长22.8小时（7.2 - 121.3小时）。老年患者延迟手术的主要原因是二次转诊和多种合并症。手术时间跨度较短（≤12小时）与美国脊髓损伤协会损伤量表（AIS）转换率较高相关（比值比4.22，95%置信区间1.85 - 9.65），调整后的样条曲线也反映了这一点（<20小时AIS转换概率为20 - 25%，20 - 60小时为10 - 20%，>60小时<10%）。在不完全性SCI中，老年患者AIS转换的概率较低[例如，“45 - 59岁”组与“≤44岁”组相比，比值比为0.09（0.02 - 0.44）]，样条曲线也证实了这一点（<40岁为20 - 80%，≥40岁为5 - 20%）。
老年患者使SCI手术治疗及研究变得复杂。解决向一级创伤中心的二次转诊和脊柱手术延迟问题是改善老年SCI患者结局的切实机会。
