Impact of patient age on morbidity and mortality in adults with acute traumatic cervical spinal cord injury: An ACS trauma quality programs database study.

Background: This study aimed to examine associations between age and outcomes in acute cervical SCI (cSCI) patients.

Methods: We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients stratified by age: 18-44, 45-65, and > 65 years. Patient demographics, comorbidities, injury type, treatment modality, AEs, and length of stay (LOS) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, NRD, and in-hospital mortality.

Results: Of the 71,048 patients identified, 19,838 (27.9 %) were 18-44 years, 26,888 (37.8 %) were 45-65 years, and 24,322 (34.2 %) were > 65 years of age. SCI rates from falls significantly increased with age (18-44: 21.7 % vs. 45-65: 47.1 % vs. >65: 71.9 %, p < 0.001). The > 65 years cohort had significantly greater rates of NRD (18-44: 64.5 % vs. 45-65: 70.4 % vs. >65: 87.0 %, p < 0.001) and in-hospital mortality (18-44: 9.1 % vs. 45-65: 8.3 % vs. >65: 19.4 %, p < 0.001). Conversely, mean LOS decreased significantly with increasing age (18-44: 14.3 ± 19.1 days vs. 45-65: 12.7 ± 16.8 days vs. >65: 10.5 ± 10.9 days, p < 0.001). On multivariable analysis, the 45-65 and > 65 years cohorts, respectively, significantly predicted any AE [1.19[ 1.11-1.27], p < 0.001; 1.18, [1.10-1.28], p < 0.001], NRD [1.41[1.29-1.5] p < 0.001; 3.46[ 3.07-3.90], p < 0.001], and in-hospital mortality [1.90[1.69-2.14] p < 0.001; 5.22[4.59-5.93], p < 0.001]. Regarding treatment modalities, cervical fusion was associated with AEs (p < 0.001), cervicothoracic fusion with AEs (p = 0.024) and NRD (p = 0.005), and excision/release (laminectomy) with NRD (p < 0.001).

Conclusion: Our study suggests that older age is associated with increased morbidity and mortality risk in acute cSCI patients.