Pilot Study: Age As A factor in Time To Surgery For Traumatic Cervical Spine Fracture Patients

INTRODUCTION: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly, who constitute an increasing percentage of the US population. Early surgical intervention is a safe, modifiable factor that enables early mobilization and subsequent reduction in complications and hospital length of stay. Surgical treatment of the elderly is complex, due to increased comorbidity factors and complications. METHODS: In a pilot study from a Level 1 Trauma Center, we analyzed the number of patients treated with cervical spine fractures with or without SCI by age group (<65, 65-84, 85) and determined the influence of age on time-to-surgery and long-term mortality. Acute in-hospital mortality was calculated and long-term mortality within the study period (2003-2013) was determined from the National Death Index. RESULTS: Data from patients (N=72) with cervical spine fractures treated surgically were analyzed, with nearly equal numbers under or over age 65. Although there was a trend of increasing time to surgery with increasing age, there was no statistical difference between the age groups (p=0.7015). The average time to surgery was less for patients with SCI than for all patients, and less for patients with than without central cord syndrome. The average time to surgery was longer for patients with vertebral fractures than for patients with SCI. There was no statistical difference for in-hospital or long-term mortality for patients with or without SCI or among the time-to-surgery groups. However, this is likely due to the low number of cases in this pilot study. CONCLUSION: Data from this pilot study indicate an association between time to surgery and survival status of patients in any age or time-to-surgery groups examined. This analysis will enable a larger future prospective study and local quality control initiatives to collect additional data on factors influencing time-to-surgery in patients with cervical spine fractures.