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)

Introduction:

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.

Methods:

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.

Results:

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).

Conclusion:

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.