1590. Hypoalbuminemia and Dependent Functional Status as Predictors for 30-Day Morbidity and Mortality in Patients Undergoing Surgical Treatment for C2 Body Fractures

Authors: Jonathan Pishoi Nakhla, MD; Yaroslav Gelfand, MD; Rafael De La Garza Ramos, MD; Murray Echt, MD; Sean Barber, MD; Sanjay Konakondla, MD; Jared Fridley, MD; Adetokunbo Oyelese, MD, PhD; Albert Telfeian, MD, PhD; Ziya Gokaslan, MD (Providence, RI)


C2 vertebral body fractures account for more than 20% of all cervical spine fractures. The purpose of this study is to investigate and identify predictors of complications in patients undergoing surgery for the surgical treatment of C2 vertebral fractures.


Patients undergoing surgery for the C2 vertebral body fractures were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2016, using ICD 9 and ICD 10 codes for this condition as well as CPT codes for posterior C1-C2 arthrodesis and anterior treatment of second vertebral fracture. Pre-operative lab values, demographic details, and comorbidities were reviewed. A multivariate analysis was used to identify the predictors of non-neurologic surgical complications and mortality within 30 days of surgical intervention.


A total of 253 patients who underwent surgery for C2 vertebral fracture were identified. Overall, the morbidity and mortality rate were 11.9% and 7.5%, respectively. After multivariate analysis hypoalbuminemia (Albumin <3.5 g/dL) was an independent significant predictor of 30-day postoperative complications (OR 3.3 95% CI: 1.3-8.3, p=0.01). Although age and smoking were significant predictors of 30-day mortality on univariate analysis, on multivariate regression only dependent pre-operative functional status was a statistically significant predictor of mortality (R 3.4 95 %CI 1.03-11.2, p=0.04).


Pre-operative hypoalbuminemia is a significant predictor of non-neurologic complications in patients requiring surgical intervention for second vertebral body fractures. Dependent functional status is the only significant predictor of mortality.