1546. Do Concurrent Cervical and Non-Cervical Injuries Increase Risk of Mortality, Readmission, and Extended Length of Stay: Investigation of 70 Elderly Patients with Traumatic Odontoid Fractures
Authors: Peter Gust Passias; Frank Segreto; Christopher Varlotta; Cole Bortz; Samantha Horn; Muhammad Burhan Janjua; Joseph Baker (Brooklyn Heights, NY)
Traumatic fractures(fx) of the cervical spine, although rare, are associated with significant morbidity and mortality. Our goal was to assess increases in mortality, readmission, and LOS in odontoid fracture(C2fx) patients with concurrent injuries
C2fx patients >65 y/o were included. Age, gender, race, charlson comorbidity score(CCI), modified frailty index(mFI), injury mechanisms(MOIs), concurrent injuries, and treatment types were described. Pearson bivariate correlations assessed associations between concurrent injuries, 90-day readmission rates, length of stay(LOS), 30-day and 1-year mortality rates. Forward stepwise logistic regression models(covariates: age, gender, C1, C3, Multilevel, Pelvic, Femur, Rib fxs) identified predictors of 90-day readmission, extended LOS(>75th percentile), 30-day and 1-year mortality rates.
70 patients were included (Age: 80.6±8.5, Gender 60%F, 88% European, 10% Maori/Pacific, 1.4% Asian, CCI 5.3± 2.2, mFI 0.21±0.15). Common MOIs were falls(74.3%), pedestrian accidents(2.9%), high and low speed MVAs(17.1%, 5.7%). 30% of patients had concurrent cervical injuries(20% C1, 7.1% C3, 2.9% multilevel); 20% had concurrent non-cervical injuries(10% ribs, 7.1% pelvis, 2.9% femur). Treatment included hard collars(54.3%), soft collars(14.3%), surgery(11.4%), minerva braces(11.4%), halo devices(7.1%), or traction/tongs(1.4%). Mean LOS was 10.4 days. 14.3% of patients died within 30 days of admission, and 35.7% within 1-year. Cervical(C1, C3, multilevel) and non-cervical(pelvis, ribs, femur) fxs were not associated with readmission, 30-day and 1-year mortality (p>0.05). Multiple regression analysis determined only concurrent pelvis injuries predicted extLOS(OR: 13.3[1.4-128.5], p=0.025), (R2=0.131).
Additional fractures to the cervical spine, pelvis, femur, or ribs posed no additional risk of 90-day readmission, inpatient mortality or mortality within 30-days or 1-Year of admission for odontoid fx patients. However, patients with concurrent pelvis fractures were 13x more likely to have an extended LOS.