Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Eur Spine J. 2024 Jan;33(1):185-197. doi: 10.1007/s00586-023-07919-7. Epub 2023 Sep 15.
To investigate the association between treatment, comorbidities, concomitant injuries, and procedures with in-hospital mortality in patients aged 80 years or older with axis fractures.
Data were extracted from the German InEK (Institut für das Entgeltsystem im Krankenhaus) GmbH database (2019-2021) for patients aged 80 years or older with axis fractures and the in-hospital mortality rate was calculated. Differences in comorbidities and concomitant diseases and injuries were analyzed using the Chi-square test. In surgically treated patients, odds ratios (OR) with 95% confidence intervals (95% CI) were used to analyze potential risk factors for in-hospital mortality.
Among 10,077 patients, the in-hospital mortality rate was 8.4%, with no significant difference between surgically (9.4%) and non-surgically treated patients (7.9%; p = 0.103). The most common comorbidities were essential hypertension (67.3%), atrial fibrillation (28.2%), and chronic kidney disease (23.3%), while the most common concomitant injuries were head and face wounds (25.9%), concussions (12.8%), and atlas fractures (11.6%). In surgically treated patients, spinal cord injury (OR = 4.62, 95% CI: 2.23-9.58), acute renal failure (OR = 3.20, 95% CI: 2.26-4.53), and acute bleeding anemia (OR = 2.06, 95% CI: 1.64-2.59) were associated with increased in-hospital mortality (all p < 0.01). Screw-rod-system fixation of one segment (OR = 0.74, 95% CI: 0.56-0.97) and intraoperative navigation (OR = 0.45, 95% CI: 0.16-0.71) were identified as potential protective factors (both p < 0.05).
Comprehensive geriatric assessment and optimization of comorbidities during treatment are crucial. The indication for surgical treatment must be carefully individualized. Future studies should focus on the choice of surgical technique, perioperative blood management, and intraoperative navigation as potential protective factors.
研究 80 岁及以上脊柱骨折患者的治疗、合并症、伴随损伤和手术与院内死亡率之间的关系。
从德国 InEK（Institut für das Entgeltsystem im Krankenhaus）GmbH 数据库（2019-2021 年）中提取 80 岁及以上脊柱骨折患者的数据，并计算院内死亡率。采用卡方检验分析合并症和伴随疾病及损伤的差异。对手术治疗患者，采用比值比（OR）和 95%置信区间（95% CI）分析院内死亡的潜在危险因素。
在 10077 例患者中，院内死亡率为 8.4%，手术治疗组（9.4%）与非手术治疗组（7.9%）无显著差异（p=0.103）。最常见的合并症是原发性高血压（67.3%）、心房颤动（28.2%）和慢性肾脏病（23.3%），最常见的伴随损伤是头面部创伤（25.9%）、脑震荡（12.8%）和寰椎骨折（11.6%）。在手术治疗患者中，脊髓损伤（OR=4.62，95%CI：2.23-9.58）、急性肾衰竭（OR=3.20，95%CI：2.26-4.53）和急性出血性贫血（OR=2.06，95%CI：1.64-2.59）与院内死亡率增加相关（均 p<0.01）。单节段螺钉棒系统固定（OR=0.74，95%CI：0.56-0.97）和术中导航（OR=0.45，95%CI：0.16-0.71）被确定为潜在的保护因素（均 p<0.05）。
综合老年评估和治疗期间合并症的优化至关重要。手术治疗的适应证必须个体化。未来的研究应侧重于手术技术的选择、围手术期血液管理和术中导航作为潜在的保护因素。
