Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: Advanced age has been associated with inferior outcomes and greater healthcare resource utilization in patients undergoing spinal surgery. The aim of this study was to determine the impact of increasing age on postoperative outcomes in patients treated for odontoid fractures.
Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. All patients ≥50 years old who underwent surgery for odontoid fractures, identified using ICD-10-CM coding, were categorized by age: 50-64 years, 65-79 years, and 80+ years. Demographics, comorbidities, intraoperative variables, perioperative complications, length of stay (LOS), cost, and discharge disposition were assessed. Multivariate analyses were performed to identify the independent association between octogenarians and extended LOS, increased cost, and non-routine discharge disposition.
Results: Of the 8,325 patients identified, 2,040 (24.5%) were 50-64 years of age, 3,675 (44.1%) were 65-79 years of age, and 2,610 (31.4%) were 80+ years of age. The proportion of patients with ≥3 comorbidities was significantly higher with increasing age (50-64 years:49.3% vs 65-79 years:58.8% vs 80+ years:68.4%, p< 0.001). The proportion of patients experiencing any perioperative complication also varied significantly with age (50-64 years:20.6% vs 65-79 years:26.3% vs 80+ years:28.2%, p=0.020). The octogenarian cohort experienced significantly greater rates of non-routine discharge (50-64 years:32.6% vs 65-79 years:53.5% vs 80+ years:73.2%, p< 0.001), but had similar LOS (p=0.252) and costs (p=0.616). On multivariate analysis, compared to the 50-64 years cohort, increasing age was independently associated with non-routine discharge [65-79 years: OR:1.86, CI (1.36, 2.54), p< 0.001; 80+ years:OR: 4.62, CI (3.18, 6.71), p< 0.001]. However, advancing age was not significantly associated with extended LOS [65-79 years: p=0.614; 80+ years: p=0.112] or increased cost [65-79 years: p=0.101; 80+ years: p=0.808].
Conclusion : Our study found advancing age was significantly associated with increased rates of non-routine discharge, but not with LOS or costs, in patients undergoing surgery for odontoid fractures.