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Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

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Název: Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury
Autoři: Sanjay S. Dhall, Darryl Lau, William D. Whetstone, Jason F. Talbott, Cecilia L Dalle Ore, Phiroz E. Tarapore, Adam R. Ferguson, Geoffrey T. Manley, Vineeta Singh, Michael C. Huang, Jacqueline C. Bresnahan, Praveen V. Mummaneni, Michael S. Beattie
Zdroj: Neurosurgical Focus. 46:E3
Informace o vydavateli: Journal of Neurosurgery Publishing Group (JNSPG), 2019.
Rok vydání: 2019
Témata: Adult, Aged, 80 and over, Male, 2. Zero hunger, Critical Care, Fracture Dislocation, Age Factors, Hemorrhage, Recovery of Function, Length of Stay, Middle Aged, Decompression, Surgical, Prognosis, 3. Good health, Intensive Care Units, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Quality of Life, Humans, Female, Hospital Mortality, Aged, Retrospective Studies
Popis: OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
Druh dokumentu: Article
ISSN: 1092-0684
DOI: 10.3171/2018.12.focus18555
Přístupová URL adresa: https://thejns.org/downloadpdf/journals/neurosurg-focus/46/3/article-pE3.pdf
https://pubmed.ncbi.nlm.nih.gov/30835676
https://europepmc.org/article/MED/30835676
https://www.ncbi.nlm.nih.gov/pubmed/30835676
https://thejns.org/focus/view/journals/neurosurg-focus/46/3/article-pE3.xml
https://pubmed.ncbi.nlm.nih.gov/30835676/
https://thejns.org/downloadpdf/journals/neurosurg-focus/46/3/article-pE3.pdf
https://thejns.org/view/journals/neurosurg-focus/46/3/article-pE3.xml
Přístupové číslo: edsair.doi.dedup.....5ef54f584db84600b744f34b4fdb4fdc
Databáze: OpenAIRE
Popis
Abstrakt:OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
ISSN:10920684
DOI:10.3171/2018.12.focus18555